This study investigated the protein quality of two sets of Roselle seeds processed differently (dried and boiled). Twenty weanling Sprague Dawley rats were used to conduct the growth and nitrogen balance studies. Rats were fed with 10% (w/w) protein from dried (DS) and boiled (BS) Roselle seeds powder for 4 weeks. Casein was used in this study as a standard reference protein. There was a significantly higher (p < 0.05) food intake and weight gain by rats fed with BS compared with DS. In the growth study, there was no significant difference (p < 0.05) in protein efficiency ratio (PER) and net protein ratio (NPR) of BS compared to DS, but it was significantly different with casein (CD). PER value of rats fed with DS was significantly lower (p < 0.05) than casein. In the nitrogen balance study, true nitrogen absorption (TNA) and nitrogen balance (NB) of BS group was significantly higher (p < 0.05) than DS group. However, apparent digestibility (AD), true digestibility (TD) and biological value (BV) for both diets was not significantly different. This study showed that the protein quality of dried Roselle seeds was similar to the Roselle seeds boiled at 100oC for 30 minutes.
Processed meat products, such as burgers, sausages, meatballs, salami and nuggets are currently popular with urban consumers. However, in general, they are high in cholesterol, total lipid and saturated fatty acids. Four beef burger formulations were prepared, each containing 15% fat from either beef fat (control), palm fat (PF), red PF or a blend of PF and red PF at a ratio of 1:1 at 15% fat. A rat assay was carried out to determine lipid profile, apparent digestibility (AD) and protein efficiency ratio (PER) of rats fed with beef burger diets containing palm based fats. Treatment with PF and red PF beef burger diets did not affect the total cholesterol concentration but resulted in higher HDL-cholesterol concentration in their blood serum. The rats fed with dried burger diets containing PF and red PF had higher AD value (90.0% and 89.3%, respectively) and was not significantly different (P < 0.05) compared to the group fed with dried burger containing beef fat (90.7) over the 10 days experimental diet period. PER values of all treatments except for casein were not significantly different (P < 0.05). There was also no difference (P < 0.05) in food intake and body weight gain between all rats fed with dried burger containing different types of palm based fats. In summary, the utilization of PF and red PF in beef burger increased the HDLcholesterol and had no effect on the concentration of total cholesterol in rat blood serum. Addition of palm based fats into beef burgers did not change AD and PER.
The aim of the study is to describe the usage of dietary supplemenu among doctors working in the hospitals in Kota Bharu, Kelantan. The method used was a postal questionaire survey of the doctors, both specialists and medical officers working in these hospitals. The results showed that
only 28.7% of the doctors are taking dietary supplements. Significantly more female doctors and doctors on long term medication, were taking these supplements. The dietary supplements commonly used were multivitamins and minerals (92.3%), garlic (26.9%), vitamin C (26.9%) and
lecithin (15.4%). The majority of the doctors who took dietary supplements (60%) felt their health status have improved. These supplements were mostly obtained from hospital pharmacies. Doctors who puchase their own supplements spend between RMIO to RMIZO per month. The main reasons given for taking these supplements were that the doctors jfelt healthier' and to ‘prevent or as a supplementary treatment’ for conditions like hypercholesterolaemia, hypertension, ischaemic heart disease and cancers. There were four doctors who regularly use traditional dietary supplements. Most doctors will generally advice their patients and children to take dietary supplements regularly, as they felt that it is important for health.
Diabetes mellitus is the most common endocrine defect among children. Good diabetes management is important to give better health for both the children and the whole family. The goal of this study was to identify the level of mother involvement in children type·1 Diabetes Mellitus management, to identify factors related with mother involvement and to determine the relationships between mother
involvement and glycemic control. A cross·sectional study was carried out with 92 respondents selected by universal sampling from mothers who had diabetic children aged 5-15 years old and from medical visit appointment at University Kebangsaan Malaysia Medical Centre (UKMMC) and Putrajaya Hospital (HP1). Data was obtained through medical record and self reporting questionnaire. The study shown that 58.6% mothers had high involvement and 41.4% mothers had low involvement. Mothers' education level had a significant (p=0.0Z) relationship with a level of mother involvement. Most mothers gave high involvement in diet management (64.1%) and blood glucose monitoring (52. 7%), however most mothers gave low involvement in exercise management (63.0%) and insulin injection (60.9%). Mothers involvement in four management tasks were not statistically significant (p>0,05) with glycemic control. Mothers involvement in children diabetic management was high. There was high mother involvement in children's insulin injection and dietary intake and low mother involvement in children`s blood glucose monitoring and exercise, This study abo showed that there was no significant relationship between level of mother involvement and glycemic control.
Malnutrition is common among pediatric oncology patients. Factors contributing to malnutrition include physiological abnormalities, response to the tumors and side effects of the treatment. A pilot study was carried out to determine the nutritional status of 17 pediatric oncology patients aged 4 to 12 years old in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur. The
nutritional status was assessed via anthropometric measurements and dietary intake through 3 days repeatitive 24 hours diet recall with subjects and their carers. Biochemical profiles (serum albumin and hemoglobin) were reviewed from the medical record. Through anthropometry measurements, weight and height were used to calculate Z-scores and further determine the percentile weight-for-age, height-for-age using NCHS percentile charts (WHO 1983). Frisancho’s standards (1981) were used to define malnutrition based on MUACfor- age. Underweight as determined using z scores below -2 for weight-for-age was observed in 70.6% of the subjects. Whilst, 76.5% of the subjects were classified as stunted (z score < –2) for height-for-age. Based on MUAC-for-age percentile, the sign of severe malnutrition category (<5 percentile) was observed in 35.3% of the subject and 23.6% of the subject were in the moderate malnutrition (>5 – <10 percentile). About 70.6% of the subject had low haemoglobin (< 11 g/dl) and 29.4% of the subject were hypoalbuminemia (< 35 g/dl) . Total macronutrient intake was assessed and compared with the individual requirement (Seashore 1984) for energy and protein intake were satisfactory, except for subjects in age group 10 – 12 years who achieved only 70% of the individuals requirements. As a conclusion, although food intake of the subjects was satisfactory but chronic malnutrition was prevalent. Early recognition of malnutrition is essential in order to plan for a nutritional intervention and further enhancing the quality of life.
Key words: Nutritional status, pediatric oncology, anthropometric, dietary intake, biochemical profile.
The traditional physical and cosmetic-centered model without paying serious attention on the underlying psychosocial issues of care are ill suited to successful treatment outcome of obesity. The objective of this article is to report a case of a retired Malay army sergeant who presented with night eating syndrome (NES) with morbid obesity and dysthymia, and to discuss the psychobiological aspect of the case including to evaluate the effectiveness of the combination treatment of pharmacotherapy and cognitive behavior therapy along with diet counseling. The diagnosis was made by using the Structured Clinical Interview Diagnosis (SCID) for DSM-III-R diagnosis and the severity of depression was assessed by Hamilton Depressive Rating Scale. The patient’s body mass index was 45, He was found to have dysthymia and the Hamilton Depressive Rating Scale score was 13. We found that the combination of pharmacotherapy, cognitive behavior therapy and nutritional education with the help of the physician proved to be effective in treating morbid obesity with NES and Dysthymia.
Meal and snack patterns are associated with energy and nutrient intakes and consequently health and nutritional status. The aim of this paper is to describe the percentage of daily energy intake from meals and afternoon snack among Malaysian adults. The study included a representative sample of adults aged 18-59 years (n=7349) from a nationwide Food Consumption Survey conducted by the Ministry of Health. Information on dietary intake was obtained using a one day 24-hour diet recall (24-HDR). Dietary data on 6886 adults were analysed using Nutritionist ProTM and statistical analysis was carried out using the SPSS 13.0. The median percentage of daily energy intake is reported only for adults consuming meals and afternoon tea and by socio-demographic characteristics as well as body mass index (BMI) status. More than 80% of Malaysian adults consumed morning meals, lunch and dinner and 54% reported having afternoon tea. The median percentage of energy intake from morning meals, lunch, dinner and afternoon tea was 29.9%, 30.5%, 32.4% and 17%, respectively. There were variations in the median percentage of energy from meals and snacks according to the socio-demographic variables and BMI status. It is important to understand the eating patterns of Malaysians as the information can assist in efforts to address obesity and diet-related chronic diseases among adults.
Study name: Malaysian Adults Nutrition Survey (MANS-2003)
This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one- year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2½ plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy (ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
Nutrition surveys based on a representative sample of the Malaysian adult population have hitherto not been reported. In 2003, the Ministry of Health, Malaysia, conducted the Malaysian Adult Nutrition Survey (MANS), the first and largest nutrition survey in the country which aimed to provide detailed quantitative information on nutritional status, food and nutrient intakes, and physical activity pattern on a nationwide representative sample of adult subjects between the ages of 18 and 59 years. The survey covered four zones in Peninsular Malaysia (Central, Southern, Northern and East Coast), Sabah and Sarawak. This paper presents the mean and selected percentiles of energy and nutrient intake of 6886 subjects by selected demographic and socioeconomic characteristics. Energy contributions by macronutrients and dietary adequacy in relation to the Recommended Nutrient Intake for Malaysians are also described. Information on dietary intake was collected by trained nutritionists using a one day 24-hour diet recall. Dietary data were analysed using Nutritionist Pro, a diet analysis software and statistical analysis was carried out using the SPSS ver. 13.0. In most of the demographic and socioeconomic groups, males had higher mean energy (1776 kcal) and nutrient intake and percent achievement of RNI than females (1447 kcal). The proportions of calories derived from macronutrients were within the recommendations for a healthy diet. Intake of micronutrients such as iron, calcium and vitamin A was about 50% of RNI particularly in women. Sodium intake of Malaysians, not reported in earlier studies, is also made available. Under-reporting using the EI/BMR ratio was found in half of the population studied. The present study provides the first national estimates of energy and nutrient intake of the Malaysian adult population. Regular nutrition surveys are needed at the national level to provide valuable information on trends in food and nutrient intake, particularly among age and ethnically diverse subgroups of the population.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
OBJECTIVE: To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control.
METHODS: Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG).
RESULTS: Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = <0.01), older subjects (p=0.04) and Type 2 diabetes subjects on oral anti-hyperglycaemic medication (p = <0.01).
CONCLUSION: There were diabetes-related knowledge deficits and inadequate self-care practices among the majority of diabetic patients with sub-optimal glycaemic control.
PRACTICE IMPLICATIONS: This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.
Lifestyle modification is effective in the prevention of cardiovascular diseases. This study aimed to promote healthy lifestyle behaviours to prevent cardiovascular disease. This study was a quasi-experimental trial with a follow up of two years. The intervention group (n = 102) received intensive individual and group counselling on diet and physical activity. The comparison group (n = 84) was given minimal education through mail and group counselling. Following the intervention, both groups reduced their total fat intake through a replacement in carbohydrate intake. The saturated fat and cholesterol intake was also reduced with a larger magnitude in the intervention group. Fruits and vegetables consumption was increased within the intervention group. The intervention group showed a statistically significant reduction in their mean total cholesterol levels with an intervention effect of -0.38 (95% C.I. = -0.63, -0.14) mmol/l. This study has achieved moderate improvement in dietary intakes as well as the total cholesterol of the participants.
A case control study was carried out to investigate associations between breast cancer risk, antioxidant status and oxidative stress among women in Klang Valley and Selangor. A total of 57 newly diagnosed cases aged 30 to 66 years old participated and were matched for age and ethnicity with 139 controls with no diagnosis of cancer or other chronic diseases. An interview based questionnaire designed to collect information on demographic and socioeconomic status, as well as reproductive, medical and dietary history was used. Anthropometric measurements including weight, height, waist and hip circumference were made and a 10 ml fasting venous blood sample was taken for glucose testing and analysis of plasma vitamin antioxidants and malondialdehyde. Hair and toenail samples were taken for selenium analysis. Results showed that the mean intake of vitamin A, vitamin E and selenium among cases (606.8 +/- 334.8 microg/d, 6.1 +/- 2.4 g/d, 56.9 +/- 16.2 microg/d) was lower than controls (724.7 +/- 414 microg/day, 6.9 +/- 3.0 g/d, 60.8 +/- 17.5 microg/d, respectively) (p<0.05 for all parameters). A similar trend was noted for plasma vitamin A and E and also selenium in hair and toenails. Poor antioxidant status as indicated by low plasma vitamin A (<284.3 microg/l or <366.3 microg/l) increased risk of breast cancer by approximately two fold, whilst low plasma vitamin E (<2.5 mg/dl, <2.8 mg/dl and <3.1 mg/dl) increased the risk by two to three fold [Adjusted OR 2.97 (95% CI 1.38-3.48), 2.32 (95% CI 1.07-2.41) and 2.12 (95% CI 1.00-4.21)]. Cases had a greater level of malondialdehyde 4.4 +/- 1.1 mmol/g protein), an indicator of oxidative stress, as compared to controls (3.2 +/- 1.7 mmol/g protein) (p<0.05). A high level of MDA (> or = 4.8 mmol/g protein) was associated with breast cancer [Adjusted OR 6.82 (95% CI 1.95-23.9)]. It is concluded that a poor antioxidant status and high oxidative stress are associated with breast cancer risk. Thus, it is essential for Malaysian women to obtain a good antioxidant status by consuming a diet rich in vitamins A and E as well as selenium and adopt healthy behaviour to reduce oxidative stress in order to prevent breast cancer.
Obesity is highly prevalent among patient with schizophrenia. It is therefore important to know whether lifestyle factors could contribute to obesity. The objective of this paper is to study the prevalence of overweight, obesity and high waist circumference (WC) in relation to Binge eating and lifestyle factors among patients with schizophrenia. This is a cross sectional study for a period of three and a half months which systematically selected patients with schizophrenia who fulfilled the inclusion criteria. The diagnosis of schizophrenia was made using Structured Clinical Interview for DSM-IV (SCID). The diagnosis of Binge Eating Disorder (BED) and the assessment of lifestyle factors were made using Eating Disorder, Module H of SCID and Health Promoting Lifestyle Profile II (HPLP II) respectively. The prevalence of overweight was 39.2 %, obesity was 35.1 % and high waist circumference was 63.9 %. The difference between presence of BED among patients who had normal and either overweight or obese was not significant (?2 with Yates correction 3.34, p=0.06). BED was found to be more in patients with high WC (n=11, 78.6 %) than those with normal WC (n=3, 21.4 %) but the difference was not significant (?2=1.88, p=0.21). In term of lifestyle factors, no significant different found between those who smoke and those who did not smoke in relation to BMI (?2=0.00, p=0.98) and WC (?2=0.15, p=0.90). There was no difference between total score of diet and exercise among patients who had normal weight and those who were either overweight or obese in relation to BMI (t=1.30, p=0.20) and WC (t=0.91, p=0.36) and BMI (t=0.80, p=0.43) and WC (t=0.02, p=0.98) respectively. There were also no differences between total score of all four domains of psychological lifestyle i.e. stress management, health responsibility, spiritual growth and interpersonal relationship among patients who had normal weight and those who were overweight and obese in relation to BMI and WC (p>0.05). Presence of Binge eating disorder and the lifestyle factors did not contribute to obesity among patients with schizophrenia. Keywords: Schizophrenia, obesity, lifestyle, binge eating disorder
Objective :This study was performed to determine changes in diet and lifestyle among breast cancer survivors in Malaysia.
Methods :This was a qualitative study done on fifteen survivors (8 Malays and 7 non-Malays) obtained from the Oncology and Surgery Department, National University of Malaysia Hospital. The study was conducted using a semi-structured interview format. The data obtained were sorted into various categories via content analysis.
Results :Majority of breast cancer survivors increased their fruit and vegetable intake following diagnosis. Some non-Malays changed to vegetarian whereas all the Malays remained on the same dietary pattern. As far as exercise was concerned, all Malays did not exercise before diagnosis, but did so after diagnosis, whereas most of non- Malays did not exercise either before or after diagnosis.
Conclusion : Some changes were noticed in dietary and lifestyle behaviors after diagnosis among some survivors. The differences were due to their different cultural and religious backgrounds.
Food frequency questionnaire (FFQ) is a practical tool for the measurement of usual food intake in large surveys because it gives a quick approximation to 'true' dietary intake. This study was carried out to compare the semiquantitative FFQ with three day 24-hour diet recalls (24-hr DR) in assessing intake of energy, total fat, fatty acids and vitamin A, C and E among Malaysian women. This semi-quantitative FFQ which was developed specifically for the Malay and Indian ethnicities has 200 food items and categorized according to three mealtimes namely breakfast, lunch or dinner and morning or afternoon snacks. A total of 51 Malay and 28 Indian women aged between 30 to 60 years were selected as study subjects. The result of the study shows that majority of study subjects were within the normal EI/BMR ratio when their energy intake was assessed by semi-quantitative FFQ (70%) and 24-hr DR (74%). However, 10% of study subjects became over-reporters when their intakes were assessed using the semi-quantitative FFQ. Analysis of t-test shows there is no significant difference (p > 0.05) on the mean intake of energy, total fats, saturated, monounsaturated and polyunsaturated fatty acids and vitamin A, C and E between semi-quantitative FFQ and 24-hr DR. Percent mean differences were also less than 10% for all nutrients included in this study. This indicates that the semi-quantitative FFQ can produce comparable results with 24-hr DR. Energy adjusted correlation coefficient values for all studied nutrients were total fat (r = 0.64, p = 0.02), saturated fatty acids (r = 0.59, p = 0.01), monounsaturated fatty acids (r = 0.52, p = 0.03), polyunsaturated fatty acids (r = 0.57, p = 0.02), vitamin A (r = 0.69, p = 0.01), retinol (r = 0.55, p = 0.01), beta carotene (r = 0.74, p = 0.01), vitamin C (r = 0.64, p = 0.02) and vitamin E (r = 0.69, p = 0.01). Cross-classification for both methods into quartiles of intake resulted in correct classification into the same or adjacent quartile from 82% to 96% of the study subjects. Only 3% of the subjects were grossly misclassified. As a conclusion, this semi-quantitative FFQ gives estimation as good as 24-hr DR for intakes of energy, total fat, fatty acids and vitamin A, C and E among Malaysian women specifically for the Malay and Indian ethnicities. This semi-quantitative FFQ is a useful tool in dietary intake assessment for research use especially for epidemiological study on diet and disease relationship such as cardiovascular, cancer and diabetes.
Objective: To describe the setting up of a pilot project on weight management programme for patients with severe mental illness (SMI) in a general hospital setting, the effectiveness of the programme on 5 patients and the feasibility of such programme to be developed in our local setting. Methods: Key staff members from relevant disciplines were involved through out the programme, which was based on dietary education, exercise and behavioural techniques. It was conducted weekly for physical exercise and biweekly for topic discussion with a total duration of 16 weeks. Results: Patients achieved means (SDs) weight loss of 1.78 (2.83) kg; BMI reduction of 0.92 (1.41) kg/m2; and reduction of waist circumference of 6.8 (4.97) cm. Factors associated with positive health outcome were high baseline BMI, high educational level and committed family members. Conclusion: The programme appears to be effective for patients and is feasible to be developed in Malaysian hospitals.
Ginger extract has been reported previously by our group to exhibit anticancer and an-tioxidant effects by reducing tumour burden and lipid peroxidation respectively in he-patocarcinogenesis induced rats. The current study examined the expression of pro-apoptotic protein caspase-8 and anti-apoptotic protein Bcl-2 in hepatocarcinogenesis treated rats. Thirty normal male Wistar rats were divided into 5 groups based on the diet given: i) control (normal rat chow), ii) olive oil, iii) ginger extract (100mg/kg body weight), iv) choline deficient diet + ethionine, CDE (to induce liver cancer) and v) CDE+ ginger extract. Rats were killed at week 8, and liver tissues were excised for immuno-histochemical study to identify pro-apoptotic and anti-apoptotic proteins, caspase-8 and Bcl-2. The observation on H&E staining confirmed the CDE diet induced liver can-cer as indicated by the presence of numerous oval cells. Identification of Bcl-2 expres-sion showed that 91.6% (11/12) of the samples from the CDE group revealed positive staining while treatment with ginger extract however inhibited the expression with only 8.4% (1/12) samples showing positive staining for Bcl-2. As for caspase-8 protein, 41.7% (5/12) of the samples from CDE group showed positive staining, which in-creased to 100% (12/12) with ginger extract treatment. Our findings suggest that gin-ger extract has an anticancer effect by inducing apoptosis in liver cancer cells via up-regulation of the expression of pro-apoptotic protein, caspase-8 and down-regulation of the expression of anti-apoptotic protein Bcl-2.
Issues and opportunities for RDA harmonization within the SEA region were first raised during the First Regional Forum and Workshop "RDAs: Scientific Basis and Future Directions", held in Singapore in March 1997. A regional review on RDAs in SEA showed general similarities for the different RDAs, although in some cases a country listed an exceptionally high or low RDA for a particular nutrient for a specific group. It also revealed differences in physiologic groupings and reference body weights, nutrients included and units of expression. Realizing these differences in RDA components between countries which makes technical composition different, a consensus on the need for regional collaboration and harmonization of RDAs was reached by participants from Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam. A follow-up workshop was organized to work towards agreement throughout the region on common approaches, concepts and terminologies; application and uses, format and a research agenda. Round table discussions were held to arrive at specific recommendations for achieving harmonization. While divergence in opinions were expected, some clear-cut agreements were settled. Globalization envisions to achieve economic growth and development, with the effects expected to ripple through health, nutrition and welfare improvements. The harmonization of RDAs in SEA seeks to reach this vision by strengthening R and D capabilities (both logistic and manpower) within the region and within the countries in the region, as well as harmonizing the efforts of governments and industry within the region to reduce potential trade barriers such as those relating to food and nutrition quality assurance standards.