Functional foods from the dietetic perspective in Malaysia. (Viewpoint).

Abstract

The area of functional foods and nutraceuticals is still actively being researched. In Malaysia, the definition of functional foods is still inconclusive. However, direct selling outlets throughout the nation are flooded with these food items since they are distributed under the food supplement category and not covered by the Food and Drug Act. As scientists, dietitians require results from clinical trials before health claims can be made regarding a particular product and the issue of dose of the food component used for therapy is also questionable. Currently dietitians have to protect the consumers from false claims and high costs imposed by direct sellers. Dietitians advocate the practice of healthy lifestyle, including healthy eating via natural foods and ingredients and not costly supplements. They need to be more assertive in promoting healthy eating and lifestyle campaigns to educate the public.

Key words: functional foods, nutraceuticals

Introduction

Malaysia has achieved economic and political stability during the past thirty years. This has resulted in affluence, change in lifestyle including food habits and rapid population growth (1). A large percentage of the population is comprised of young children and adolescents but the middle aged, young elderly and older elderly are rapidly increasing. The increase in the older population is attributed to a number of factors including quality care and an increase in life expectancy for males, that is now 69 years and 72 years for females. Adults aged 35 to 65 years represent about 50% of the population. This group is in the phase of economic stability and experiencing change in lifestyle. Many have risk factors for chronic diseases such as cardiovascular disease, diabetes mellitus, hypertension, gout, osteoarthritis and cancer. They provide a vulnerable target group for direct sellers of health products going door-to-door making health claims for functional foods and health foods. Consumers obviously need infor mation on food, diet and health lifestyles from health professionals.

Definition

Foods and beverages, which are beneficial to health, are referred to as functional foods. In Malaysia, the definition of functional foods and nutraceuticals is still inconclusive. Nutraceuticals and functional foods in Malaysia are distributed under the food supplement category and not covered by the Food and Drug Act. In trying to control the quality and safety of these products to the consumers, the Malaysian government under the jurisdiction of Ministry of Health has assigned three bodies to participate in the implementation of laws concerning nutraceuticals and functional foods (2). The three bodies are the Department of Food Quality Control, Ministry of Health; the Malaysian National Codex Committee; and the National Pharmaceutical Bureau (3).

Registration for nutraceuticals and functional foods substances should be made by the distributor in the Department of Food Quality Control, Ministry of Health. Only nutraceuticals and functional foods in their original substrate form can be registered. Others such as in tablet form should be put under the National Pharmaceutical Bureau, as highlighted in the Drugs and Cosmetic Act, 1984. The Department of Food Quality Control will check the label of the product to determine its composition. Acts and regulations used in this confirmation are the Food Acts 1983 and Food Regulation 1985 (4,5). Products that are of unknown nutrient composition or are hazardous to health are rejected. The manufacturer can be charged if the appropriate law is violated.

Examples of usage of functional foods in other countries

Legislation concerning health claims for foods and ingredients vary on a global basis (see Table 1) (6).

Japan has provided an example for Malaysia to consider concerning functional foods and health claims. In Japan the term functional food has a similar meaning to nutraceuticals but is different to health foods (7). In 1984 scientists coined the word 'functional' and outlined three functions of food namely: the primary function is nutrition; the secondary function is sensory satisfaction (flavour, aroma, taste); and the tertiary function is fortification and modulation of physical systems.

It is from the third function the term 'functional foods' was made. As early as 1947 regulations were made concerning foods for special dietary uses. These categories included foods for medical purposes, pregnant women, infants, the elderly, and specified health use (FOSHU) (8).

FOSHU products contain ingredients such as oligosaccharides and dietary fibres believed to confer health benefits. Examples include yoghurt, cereal, cooking oil, table sugar and noodles. Most claims are vague e.g. 90% of the approved food products relate to gastrointestinal benefits carrying claims such as this food helps maintain a good gastro-intestinal condition, rather than any specific functions. The FOSHU products are highly marketed and 50% of FOSHU sales are in supermarkets and 24% of door-to-door sales are FOSHU products. In 1999 about 100 products were approved (2).

New strategies for dietitians and nutritionists in Malaysia

The scenario in Japan was analysed and a decision made as to whether Malaysia would adopt the Japanese model. However it was decided that resources and efforts should be used to promote the Food Pyramid and healthy eating for the nation.

The Malaysian Food Pyramid incorporates a variety of foods comprising all nutrients required for health. This includes cereals and grains that are not processed as the broad base of the pyramid (energy and dietary fibre sources) followed by taking three to five servings of fruits and vegetables especially green leafy vegetables and fruits, (sources of multiple vitamins and minerals and fibre). The next level is to include two small to moderate servings of fish, chicken, lean meats, beans, tofu and a glass of milk as the source of protein, vitamins and minerals. The top most level is fats, oils, salt and sugar and it is advocated to cut down on these food items because of negative effects on health.

The Food Pyramid approach advocates good diet to ensure health rather than single food items or food ingredients to prevent disease. Pharmaceutical and nutritional therapies are recommended for disease management rather than functional foods or health foods. The public should be educated and protected from inappropriate nutrition and health management that can be both hazardous to their health and very expensive.

Incorporation of foods beneficial to health into Malaysian food-based dietary guidelines

Currently the only health claim dietitians should make to the Malaysian public is that eating a variety of foods based on the Food Pyramid will help ensure health. Expensive functional foods and health foods are not advocated. Food components shown by research to be beneficial to health such as phytochemicals, fibre, minerals and vitamins should be consumed in foods like oats, beans, vegetables and fruits that are easily available.

Food beliefs

The presence of food beliefs in Malaysian culture is still prevalent especially among sick individuals, post-partum women and subjects having certain disease conditions. The consumption of certain health foods can co-exist with the food avoidance placing the individual at greater risk. The practice of taking health foods or functional foods with health claims, distributed by direct sellers or purchased elsewhere, should be stopped since the claims made may be false. A further danger is that patients may stop seeing their doctor at the same time. The approach for dietitians should be to counsel patients to substitute the food items avoided with a food of similar nutritional composition and at the same time to advise the patients to improve their nutrient intake by adding more variety to their diet based on the Malaysian Food Pyramid. It is more important for a dietitian to assess the nutritional status of the patient and try to modify the food intake and incorporate other foods into the diet that are beneficial.

Combating false claims to protect the safety of consumers

Treatment is the right of the individual, however, informed consent is required. Even though dietitians advocate healthy eating to ensure health, the choice whether to follow the advice or not is up to the individual. It is very important that dietitians in Malaysia be more assertive in their nutrition education and be role models in advocating healthy eating and lifestyle. In some circumstances, there are medical professionals, including dietitians, who themselves either consciously or subconsciously are promoting these health foods or functional food products. It is therefore very important that the public is not confused as to whether to listen to direct sellers and advertising or to follow the diet advised by the Food Pyramid. Busy individuals may rather skip meals and swallow a supplement or eat functional food items or health foods instead of taking a balance of nutrients in their daily diet. The Malaysian Dietitian's Association together with the Malaysian Nutrition Dietitians Society have jointly cond ucted road shows throughout the nation to screen the health and nutritional status of the public. Public forums, talks and dietary counseling are conducted during these activities. Since April 2002 the month of April has been declared as Nutrition month in Malaysia. Various activities are conducted that are planned to make the public aware of the importance of good nutrition based on the Food Pyramid and dietary guidelines.

Conclusion

In summary, Malaysia is currently not pursuing health claims on food and food products. Despite this products either in the form of foods, capsules, or powders that fall under the category of food supplements, are making health claims and actively marketed in the country. These products should be reported to the Ministry of Health for removal from the marketplace. Dietitians should be more assertive in promoting healthy eating and healthy lifestyle. They should be alert to new research regarding beneficial effects of foods and food components and ensure they are incorporated into the Food Pyramid as part of a balanced diet for Malaysians.

Table 1

Countries making claims for food and ingredients


USA                     Calcium and bone health
                        Dietary fibre and cancer
                        Fruits and vegetables and
                         cancer
                        Sodium (salt) and hypertension
                        Folate and neural tube defects
                        Soy protein and cholesterol
Australia               Health claims not allowed,
                         folate and neural tube
                         defects and under trial
China                   Health claims based on
                         scientific data in China
Taiwan                  Health claim is case by case
Europe                  The new novel foods
                         regulation. A health claim
                         must be sustained
Japan                   Food registered under FOSHU
                         provide scientific evidence
                         regulations including claim
                         made
Philippines             Regulation on health claims
                         similar to USA
Singapore and Malaysia  Foods products are not allowed
                         to make any health claims
Thailand                Any clams made must be
                         sustained

References

(1.) Dzulkifli AR. Ubat Palsu: Melindungi Hak Pengguna. PenawaRacun. 15 July 1997.

(2.) Fatimah A, Mohd Rizal MR. Regulatory requirements on health claims for nutraceuticals and functional foods in Malaysia. 1999. Proceedings of Conference on Marketing Nutraceuticals and Functional Foods; 20-21 January 2000, Singapore.

(3.) Malaysian National Codex Committee. Kuala Lumpur: Codex and International Affairs Office; 1971.

(4.) Food Act 1983. Ministry of Health Malaysia. Sect 13-28; 1983.

(5.) Proposed Amendment of Food Regulations 1985. Ministry of Health Malaysia; 1999.

(6.) The function of foods. Food Facts Asia 1996;6.

(7.) Nakajima K. Regulatory Update of Foods for Specified Health Uses (FOSHU) and a Profile of the Market. Japan Health Food and Nutrition Food Association Scientific and Regulatory Affairs, 1999.

(8.) Fatimah A, Hanafiah MS, Idris MN, Che Nu MS. Intervention in an iron surveillance program among antenatal mothers in Kuala Lumpur and Kuala Selangor. Aust J Nutr Diet 1998;55:365.

Department of Nutrition and Dietetics, Universiti Kebangsaan, Malaysia

F. Arshad, PhD, GradDipDiet, MSc, BSc, Professor

Correspondence. F. Arshad, Professor, Department of Nutrition and Dietetics, Faculty of Allied Health Services, Universiti Kebangsaan, Malaysia. Email: [e-mail]