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  • Published: 25 November 2019

The authentic balut: history, culture, and economy of a Philippine food icon

  • Maria Carinnes P. Alejandria   ORCID: orcid.org/0000-0001-5867-4970 1 ,
  • Tisha Isabelle M. De Vergara 1 &
  • Karla Patricia M. Colmenar 2  

Journal of Ethnic Foods volume  6 , Article number:  16 ( 2019 ) Cite this article

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The practice of making and eating fertilized duck eggs is a widely known practice in Asia. In the Philippines, “balut” is a popularly known Filipino delicacy which is made by incubating duck eggs for about 18 days. However, criticisms against its authenticity and the unstable demand for balut in the market pose challenges to the development of the Philippine balut industry. Consequently, this research aims to trace the history of balut production and consumption in the Philippines by specifically looking into the following. First, it explores the factors that contribute to the discovery and patronage of balut. Second, it identifies the localities that popularized the balut industry. Third, this includes the key industries that started the large scale production of balut. Fourth, it discusses the local ways of balut-making practices in the country. Lastly, it also provides an account of the ways of balut consumption. Through content analysis of secondary data, this research argues that balut remains an authentic Filipino food despite shared patronage in several Asian countries through the localized meanings associated with its consumption, preparation, and distribution.

Introduction

Balut is a popularly known Filipino delicacy made from incubated duck eggs. It is the main product of the duck industry in the Philippines [ 1 , 2 ] followed by salted duck eggs locally known as “itlog na maalat” [ 3 ]. Its name was derived from the traditional way it was prepared—“balut” which plainly means “wrapped” or covered inside bags during its incubation process. The perfect balut is incubated for 17 to 18 days while its embryo is still wrapped with a whitish covering and has not yet fully developed [ 4 , 5 ]. This is locally known as “balut sa puti” which literally means “wrapped in white.”

Despite the popular association of the consumption of fertilized duck eggs or incubated eggs to the Filipino cuisine, it has been documented to have existed and continuously patronized in many Asian countries. It has been identified that fertilized duck egg consumption was originally developed in China to extend the shelf life of the eggs before the discovery of refrigerators [ 6 ]. It was called “maodan” or literally translated as “feathered” or “hairy egg,” as feathers are still visible when it is cooked. In Vietnam, a similar food preparation is called as hot vit lon , while it is famous as phog tea khon in Cambodia. The main point of differentiation among these duck egg products is the length of the incubation process. The Vietnamese prefer the egg to be incubated for 19 to 21 days so that the embryo will be firm when cooked [ 5 ]. Similarly, it is incubated for 18 to 20 days in Cambodia. At present, it is still popularly known and commonly consumed in most East and Southeast Asian countries, including Laos and Thailand [ 7 ].

During the sixteenth century, the practice of making incubated eggs was believed to be brought by Chinese traders to the Philippines when they settled along the shorelines of Laguna de Bay [ 8 ]. At that time, a particular town near the area has an abundance of Mallard ducks, locally known as “itik.” Itik or more notably known as Pateros itik are being raised mainly for its eggs. This type of duck is being preferred than meat-type ducks because of the local demand for egg production [ 1 ]. In general, ducks are known to adapt in almost all kinds of environmental conditions and varying feeding practices and have immunity to common bird diseases [ 9 ]. This municipality initiated and popularized the process of making incubated eggs which is now famously known as “balut.” Duck farming has been considered as a significant livelihood in many Asian countries [ 10 ]. In the Philippines, balut is the primary product of the industry. In 2015 and 2017, the total egg-based production of the Duck industry has been estimated to be 42 thousand metric tons and 45 thousand metric tons respectively which signify its constant and increasing demand from consumers in the Philippine Market.

Food has been the focus of study among researchers in describing the socio-cultural landscape of a society. In some works, food is used as a point of discussion of history [ 11 ], policy development [ 12 ], and even societal hierarchies [ 13 ] and inequalities [ 14 ]. This current work contributes to the growing literature of food studies, as it traces the socio-historical narratives of the Filipino people in relation to the polarizing ethnic food called balut. Accordingly, the main objective of this study is to trace the history of balut making and consumption in the Philippines. In particular, this would be discussed according to five sub-objectives. First, this study aims to identify the factors that contributed to the discovery and patronage of balut by looking into the economic, social, and cultural contexts. Second, this study maps out the localities that popularized the balut industry in the country. Third, this study also intends to specify the key industries that started off the large scale production of balut. Fourth, this work discusses the local processes of making balut and the various ways of its consumption. It is through the latter three objectives by which this paper positions balut as a distinct Filipino food despite its wide distribution and patronage in Asia.

With these objectives, this study employed a qualitative exploratory design. This study is primarily a scoping review of existing literature on the Philippine duck industry. It also employed content analysis of the secondary data which consisted of historical documents and current literature. Accordingly, this method makes use of existing data to be able to establish what is already known [ 14 ]. This was also used to provide a comprehensive understanding of the balut industry and its development in the Philippines. The data included a variety of sources including journal articles, books, published reports, and news articles. These bodies of literature were assessed and categorized into themes that created the conceptual markers for the documentation of a cultural narrative of balut in the country. The thematic analysis was produced through the usage of qualitative data analysis software with specific use of closed coding and axial coding processes.

The popularity of balut in most Asian cultures led to the curiosity of Western countries. Foreigners have deemed it as “exotic” and it has been included to the “most disgusting, strange, terrifying food list” [ 15 ]. Consequently, it is characterized as an aphrodisiac or a sexual stimulant [ 16 ] together with other foods that are considered exotic [ 17 ]. Most of the balut’s reputation in other countries are based on the belief that it only serves as an item for doing extreme food challenges and as a proof of masculinity. As a result, it has been a popular snack for men which could be considered as a contributing factor in selling balut at night time. This perspective towards the balut has crossed the mainstream media as several reality television shows, such as Fear Factor and Survivor, which are reputable for showcasing the most extreme and daring challenges, had featured balut eating challenges. In those challenges, contestants had to eat balut under time constraints to be able to advance to the next level. The pained expression on their faces depicts a negative portrayal of balut on national television. This kind of shows presents an exaggerated one-dimensional representation of this delicacy [ 18 ]. Hence, television viewers will immediately assume that such delicacy tastes bad or is unpleasant by purely basing on how the television show presented its physical appearance. When the balut is cracked open, one might find it disgusting to see the embryo forming (see Fig. 1 ). In some instances, the chick may already be showing its beak and is already growing feathers.

figure 1

Balut sa puti (18 days)

In most Western cultures, balut has also been considered a taboo [ 19 ], specifically because of its high fat content. The growing trend for health consciousness [ 20 ] has categorized balut and other high calorie foods as unacceptable to be eaten. The issue of balut as a taboo has also been evident in some regions in the Philippines. Some ethnic groups like Mankayan Kankana-eys and Kalingas of Tabuk prohibit their pregnant women from eating balut as it may cause some defects to the development of the baby inside the womb [ 15 ]. Such beliefs are rampant and are practiced by people despite the lack of certainty or scientific proof. Meanwhile, it also raises ethical controversies as the egg is eaten while there is an embryo developing inside it [ 21 ]. This tackles an issue of moral consideration—whether it is acceptable or unacceptable to eat an unborn animal. Hence, these concerns likely influence the demand for balut in the market as well as its local consumption.

Despite such criticisms, balut has been hailed as the “national street food” of the Philippines [ 4 ] and was even considered “as popular as hotdogs in the United States” [ 22 ]. It is traditionally being sold by street vendors during the night time until early dawn. Vendors usually carry a basket where the eggs are carefully placed inside and covered with a cloth. It is also filled with some sand to retain its warmth until consumed. Accordingly, they are commonly seen on the corner of the streets, stalls, local markets, bus terminals, restaurants, along the pavement in front of disco bars, and other late night establishments [ 4 , 8 ]. Vendors may be walking, sitting, or cycling while shouting “Balut!” throughout the neighborhood. Balut are also sold by placing them on a makeshift packaging crafted from recycled newspaper or telephone directory. This also contains a small packet of salt and vinegar that is known to enrich the taste of balut.

The attribution of balut consumption to the members of the lower economic strata of society is related to the discovery of eating uncommon foods, like balut, rooted in extreme hunger [ 23 ] and lack of proper food during World War II. Filipinos during that time likely stumbled upon eating duck eggs because of the lack of “decent” food choices present [ 24 ]. Later on, it became popular as an affordable and nutritious snack [ 25 ] that was made available and accessible to all Filipinos. It has been viewed as a good alternative source of high amounts of protein and other nutrients. Balut ranks second to “isaw” or pig/chicken intestines among the most products sold along the streets [ 26 ]. Thus, it has been characterized as a mass-based snack.

During the 1990s, a significant shift from this trend occurred through the introduction of commercial duck feeds. Along with the profitability of this business, the availability of commercial duck feeds encouraged the expansion of small-scale duck farmers into large-scale producers as well as the increase of new commercial operators. Traditionally, duck farms establish their businesses near rivers and lakes since it provides natural food sources for ducks such as snails and shells [ 8 ]. With the introduction of commercial duck feeds, duck farmers who are geographically far from fresh bodies of water were also able to start and maintain their own farm businesses. Subsequently, this expanded the balut industry to other provinces. In 2018, the number of commercial duck farms had an increase of 5.59%, while backyard farms only went up by 2.89% [ 27 ]. Consequently, the duck farming in the Philippines may be classified into two types: small-scale or backyard and commercial. Its main point of comparison depends on the number of duck heads regardless of its breed. It is considered as commercial when the farm has more than 100 heads of duck unless otherwise. The duck industry in the country has also long been dominated by small-scale producers. It was estimated that about three quarters of duck egg producers are small-scale who are mainly found in rural areas [ 1 ].

The increasing demand for balut production has resulted in an increase of duck farms in the Philippines. Thus, duck farming is considered as one of the most profitable livestock industries as well as one of the major sources of livelihood among Filipinos similar to most Asian countries. In general, the Philippines dominates the duck egg production in the global market [ 3 , 28 ]. Duck farming is characterized as inexpensive and requires non-elaborate housing facilities and less space per duck head for rearing [ 29 ]. Hence, it could easily be established in a small land area or even within the backyard. As such, this industry can play a key role in alleviating poverty. The natural abundance of ducks combined with its low-cost maintenance allows even low-income communities to start up their own businesses. It provides employment and income-earning opportunities for marginal communities and rural areas [ 10 , 19 ].

Duck farming ranks second to the broiler chicken industry in the country in terms of egg production [ 10 ]. One of the reasons that the broiler industry became more advanced is primarily due to its increasing commercialization brought about by its massive demand worldwide. In 2002, about 2.69% of the total income of the Philippine agricultural sector comes from the broiler industry while duck farming contributes only about 0.43 percent [ 29 ]. Nonetheless, duck farming continues to thrive mainly because of its profitability and the growing demand for duck egg products and meat. It has been found out that duck farming is more profitable compared to chicken as it requires minimal costs and returns high profit.

As the duck farming industry increases, there is also a direct increase in duck egg production. It was estimated that about a total of 40 thousand metric tons of eggs is being produced annually [ 24 ]. In 2017, the total production of duck eggs accumulated to about 486 million pesos, having a 6.34% increase from 2016 [ 30 ]. This makes up about 1.56% of the total income of the poultry industry of the country. Although this is still a small portion of the poultry industry, the growing demand for balut has resulted in an increase in the number of duck farms and egg producers in the Philippines. About 80% of the total duck egg production is being processed for balut making [ 1 , 25 ], while the remaining 20% was allotted for the selling of raw duck eggs, penoy, and salted eggs.

Aside from raising ducks as a poultry industry, it is also now being promoted for the improvement of the agricultural sector. The integrated rice-duck farming system (IRDFS) has recently been implemented in the Philippines to increase rice productivity. This method was originally developed in Japan and has long been used in many agricultural areas in other countries. In this system, ducks were simply placed in the rice fields where they freely roam around. Additionally, the paddling movement of the ducks will serve as the “labor” in nurturing the soil. In rice fields, weeds and snails are considered as pests for growing rice. The use of ducks will serve as the “pesticide” because these are some of the natural food source of ducks. Accordingly, this eliminates the need for synthetic fertilizers and chemicals [ 2 ]. Moreover, the use of ducks for rice-growing provides farmers with a supply of duck eggs that they could sell for more income. In some provinces where IRDFS is being practiced, rice productivity increased to 9 tons per hectare from the average of 4.2 tons, yet the cost of production went down by 30% [ 31 ]. The implementation of IRDFS becomes a good option for an environmental, low-cost, and healthier way of growing rice and raising ducks. Furthermore, its growing popularity will further contribute to the increase of duck egg production in the country.

Establishing Balut in the Philippine culture

Pateros has been considered the capital of balut industry in the Philippines. It is a small and the only remaining municipality located in Metro Manila along with 16 cities (see Fig. 2 ). It is surrounded by natural bodies of water including Pateros River and Pasig River. In the 1950s, it was estimated that this town has about 400,000 ducks [ 22 ]. Accordingly, duck raising and egg production became a primary source of livelihood for its residents. Primarily, it started out as a cottage industry in this town. Later on, it developed its reputation for producing high-quality duck eggs and became a primary distributor to other provinces throughout the country. Its traditional process of balut making gained much popularity until it became a tourist attraction for Pateros [ 5 ]. The craft of balut making covers about 23% of its local industry at its peak.

figure 2

Map of the Philippines

In the 1960s, balut from Pateros were characterized with the highest quality. The balut makers were known for their careful selection of eggs. They were also able to develop a localized way of incubating eggs and processing them into products like salted egg and balut. However, massive urbanization and pollution of the Pasig River during the 1970s have led to the decline of duck farming in this area [ 32 ]. The town became uninhabitable for the ducks because their primary source of food was lost as the river became contaminated with harmful substances. As a result, the balut industry in Pateros has slowly been deteriorating since then. Nonetheless, local balut makers who still want to preserve their tradition are still able to continue their businesses by gathering duck eggs from their neighboring provinces, including Bulacan, Laguna, and Nueva Ecija [ 8 ].

In an attempt to revive the balut industry in Pateros, the local government implemented an exemption for duck egg processors from paying the local business tax as well as the annual mayor’s permit fee [ 33 ]. This allowed small-scale balut makers to gain more profit. Pateros also started its own festival called Balut sa Puti Festival to celebrate its own delicacy. This involves a cooking competition featuring balut as a main ingredient for a variety of dishes. Locals of Pateros still believe that their traditional process of balut making is what distinguishes the quality of their balut from other producers which keeps the industry alive.

The slow decline of balut industry in Pateros resulted in a sudden increase in the province of Laguna, particularly in the municipalities alongside Laguna de Bay. The province is located on the south of Manila in the island of Luzon (see Fig. 2 ). Many duck raisers from Pateros have migrated to this area in the hopes of recovering their businesses. One of the main reasons that duck farming is thriving in this area is because of the abundance of snails and shells [ 1 , 8 ]. The large-scale duck egg producers in this province are located mostly in the municipalities of Los Baños, Bay, and Victoria [ 3 ]. The town of Victoria which is located near the shoreline of Laguna de Bay is considered as the largest duck farming industry in the country. It has about 55,000 mallard ducks that hatch about the same number of eggs at a time. Like Pateros, this town also celebrates its own Itik Festival during the second week of November.

Aside from large-scale balut facilities of Laguna, it also has its own rice-duck zones in some of its towns including Sta. Cruz, Siniloan, and San Pablo. One characteristic of the duck and duck egg industry in the province of Laguna is its varying duck-feeding practices. With the abundance of natural food sources, like snails and the availability of commercial feeds, duck raisers are able to utilize both. In the town of Los Baños, farmers feed their ducks with snails every morning, while commercial duck feeds mixed with desiccated coconut in the afternoon [ 3 ]. Accordingly, the feeds are considered as a key determinant in egg production. These aquatic foods are considered as better and more natural feeds compared to the commercial ones because they help improve the quality of the duck eggs.

Central Luzon

The continuous increase of large-scale commercial duck farmers encourages the duck farming in other regions in the Philippines. From Region IV-A, where Laguna is located, the concentration of duck egg production gradually transferred to Region III (see Fig. 2 ) [ 1 ]. As of 2016, the Central Luzon is considered as the topmost duck egg-producing region in the Philippines [ 24 ] and has about an estimated 2.29 million commercial duck production. As regards to the total number of commercial duck farms in the country, two of its provinces, namely Bulacan and Pampanga, represent 28.4% and 25.7% respectively [ 25 ]. It also has the biggest duck population for commercial farms in the country. In some provinces in Central Luzon, particularly in Nueva Ecija and Pampanga, duck farms were comparatively larger in size than those in Iloilo and Quezon [ 29 ].

Western Visayas

The top duck egg-producing regions in the Philippines are Central Luzon and Western Visayas followed by SOCCSKSARGEN, Cagayan Valley, and Ilocos region [ 24 ]. Western Visayas is a region located in the island of Visayas (see Fig. 2 ). In relation to this, Western Visayas has about 1.36 million backyard ducks which is the largest number of small-scale farms in the country. The increasing accessibility of commercial duck feeds has allowed the continuous expansion of duck raising and balut making in other regions.

Aside from balut making in the islands of Luzon and Visayas, evidences of a thriving duck industry in the island of Mindanao has also been observed (see Fig. 2 ). The high demand for duck eggs for balut making had resulted in a significant increase of production, particularly in Cagayan Valley and Zamboanga Peninsula [ 24 ]. In addition, the number of duck egg grower noticeably increased, particularly in the region of SOCCSKSARGEN. By 2018, Central Luzon still tops the list followed by SOCCKSARGEN and Northern Mindanao [ 34 ]. A contributing factor to this may be the implementation of IRDFS in this region since it has a massive agricultural area.

The continuous growth of the balut industry in different parts of the Philippines evidently shows that it has long been established in the history and culture of Filipinos. The craft of balut making may be known as an influence brought by Chinese traders, but nevertheless, Filipinos were able to localize it and develop their own way of balut making and consumption.

The political economy of the balut industry: localities that popularized balut

Small-scale producers are expanding into large-scale facilities to meet the market demands for balut. However, not all are able to establish their own facilities. This caused large egg-processing facilities to purchase their eggs from small duck farms. As such, several balut makers started the large-scale production of balut in the Philippines.

In the town of Pateros, a local named Rufino Capco owns the R&M Balut Industry. Accordingly, this business started during the 1960s and has been operating since then [ 35 ]. While most balut makers in his town already left the industry, Capco still maintained his own business. From Region 3 or Central Luzon, Nanding de Jesus is a famous balut maker in the town of Sta. Maria, Bulacan. He started his business in 1979 with only PhP5600 as his capital. Initially, he placed his balut incubator or balutan inside his own house since he has no sufficient amount of money to establish a larger facility. By 1990, he was able to use his own commercial incubators that houses about 1.5 million duck eggs within a period [ 36 ]. Accordingly, he is now able to sell more than 60,000 duck eggs on a daily basis. This then supplies egg products to most of its neighboring provinces. As the first one to enter the balut industry in his town, he also encouraged his neighbors to try balut making until there were about 28 balut makers. Later on, de Jesus and his neighbors were also able to establish their own balut producers’ association.

The Jashacarl Balut and General Merchandise is also as a known large-scale commercial balut producer that started in 1993 [ 37 ]. This particular balut maker is a bit different from others as it is a combination of duck raiser, balutan, trader, and retailer, all in one. Its duck farm has about 30,000 ducks at a time and produces about an average of 20,000 balut eggs per day. It was also able to expand its industry in other places like Cavite, Las Piñas, and Quezon City.

In 1999, Cecilia Salarda was able to expand her own small-scale balut business [ 38 ]. At first, she simply buys about 60 to 100 duck eggs from nearby farms and then processes them into balut by herself. Soon enough, she was able to buy her first modern incubator. Her business continued to grow until she was able to establish her own balut and salted egg factory and employed more than 20 individuals. She then became one of the largest balut and salted egg producer in the province of Negros Occidental. The increasing popularity of balut making in the province is encouraging the industry’s future development. Moreover, it also provides a good source of income for the locals.

In Zamboanga Sibugay, a couple named Calixto and Maricris Huit have a small-scale balutan. Initially, they only had three manually operated incubators. In 2012, they received an assistance grant from the Enterprise Technology Upgrading Program (SETUP) of the Department of Science and Technology (DOST) [439]. This allowed them to grow their balutan into a large-scale business. From producing about 1000 to 2000 balut per day, they were now able to manufacture about 5000 and deliver egg supplies to other provinces, including Basilan, Dipolog and Cagayan de Oro. Their business became known as Marc’s Balut Processing Facility.

Local processes of balut making

The perfect balut consists of four main parts: embryo, yolk, bato or rock, and the broth which is sometimes also called as the “soup” [ 7 ]. In buying balut, some may choose between those that were incubated for 16 or 18 days. Individuals trying it for the first time may opt for a 16-day-old balut since the embryo is less developed and the bones and beak are much softer to chew. Still, the 18-day old balut is considered as the best balut known as “balut na puti.” This is also colloquially called “higop” which actually refers to the act of slurping all of its contents. In some cases, balut vendors located near bus terminals are intentionally selling mostly 19-day-old balut since they know that it would be unlikely to see their customers again.

Locally known, there are two kinds of balut that are being produced and sold. The mamatong refers to the type of balut wherein the embryo is floating above the yolk and the white. The other one is called as “balut na puti” or wrapped in white literally because the embryo looks like it is covered with a whitish part when sold. This is made by allowing the eggs to incubate for about 18 days. It is considered as the favorite and perfect kind of balut for Filipinos since the embryo has not fully developed its beak and has no feathers. In distinguishing the two, there is a local belief that the two types of balut may be differentiated by putting them on water. When it floats, it is a mamatong, while it is a balut na puti when it sinks to the bottom.

Traditionally, lakes and rivers serve as the sources of aquatic foods for the ducks such as snails and shells. These aquatic foods are recognized as better feeds than commercial ones as they help improve the quality of the duck eggs [ 3 ]. Meanwhile, the increase of large-scale producers that make about a thousand balut per day does not undergo the same tedious process. Hence, balut makers claim that it does not produce eggs of the same quality.

The preference for duck eggs over chicken eggs is mainly because the former has a stronger shell and shell membrane [ 5 ]. Additionally, duck eggs have a smoother shell texture than the latter. When choosing the type of eggs to be processed, balut makers prefer thick-shelled eggs than thin-shelled ones. Using the “pitik” system, balut makers tap eggs using their fingers to determine which eggs have cracks or are thin-shelled [ 5 ]. Eggs with cracks will give off an empty sound, while thin-shelled eggs produce a brittle sound. On the other hand, thick-shelled eggs are preferred because this type of egg is known to be capable of enduring the tedious process of incubation.

For the incubation, the process must start before the duck egg reaches 5 days old. To begin with, the fertilized duck eggs are placed under the sun for about 2 to 7 h to provide warmth for the eggs [ 18 ]. This is done to remove any moisture left on the eggs before they are placed in the balutan or the incubator. Then, the eggs are transferred to the baskets, inside the balutan. The traditional balutan is an improvised shelter that is usually made from bamboo and nipa palm. Most importantly, it must always be kept dark and humid inside the balutan for proper incubation to take place.

In the incubation, the eggs are being kept in the bamboo incubators that are in the shape of barrels with a normal size of three feet and two feet in width [ 7 ]. Each incubator is made to hold ten bamboo baskets that can be filled with 100 to 120 eggs each. An estimate of about 6000 duck eggs are incubated in a single period. Inside the bamboo baskets, the eggs are placed inside a tikbo (abaca cloth bags) or wrapped in panyo (sinamay fabric) [ 19 ]. The eggs are carefully wrapped to ensure that they are properly incubated. For constant warmth during the process, several bags of palay or rice husks are positioned in between the baskets [ 7 ]. The husks are heated in copper kettles until it becomes extremely hot before being placed in the balutan. In Pateros, rice husks are commonly mixed with mud for the incubation.

During the incubation, the most important part is to turn and reposition each egg for two to three times a day to ensure its consistent growth [ 39 ]. This would also prevent too much heat in a particular side of the egg which may cause it to spoil. Accordingly, the eggs must also be placed according to their age. The more mature eggs which are almost 18 days old are placed at the topmost portion, while the less developed ones, which are usually about 5 days old, are at the bottom of the baskets [ 18 ]. The advancements in the duck and duck egg industry involve innovations in the process of incubation. Local balut makers utilize mechanical incubators to have a more efficient and convenient production of balut (see Fig. 3 ). Similar to the traditional process, the duck eggs still need to be turned from each side so that each egg is able to receive equal amount of heat. Such incubators are powered by electricity to ensure constant source of heat during the process.

figure 3

Mechanical incubator in a duck farm and balut making facility in Laguna

In identifying whether a duck egg could be sold as a balut or penoy, balut makers utilize the process of candling. The eggs will be shortly removed from the incubation and will be put back when it passes the inspection of a balut maker or magbabalut [ 8 ]. At this process, each egg will be held against the hole of a lighted device called silawan during the 11th and 17th day of incubation [ 5 ]. The box-like device can be in the shape of a triangle or a square that has a light bulb inside it (see Fig. 4 ). When it is inserted in the hole, the balut maker can see the contents of the egg as it operates like an x-ray machine. In the 11th day, the balut makers are already able to identify whether the egg may be sold as a balut or not. It will show a spider-like structure and have a dark spot at the center. On the other hand, transparency means that it has not yet developed. It would simply look like a whole yolk which means that the egg is infertile. This will then be sold as penoy which is highly similar with hard-boiled chicken eggs. This occurs when the thin whitish membrane inside the egg was infiltrated with water. The detection of a penoy may be done as early as the seventh day of incubation since some magbabalut does candling at this time.

figure 4

Candling process of balut

After the incubation process, the eggs should be momentarily air-dried before immersing them in boiling water with salt. This would take about 20 to 30 min before it becomes ready for consumption [ 7 ]. A cooked balut may last for about a month when refrigerated. However, the broth will dry out quickly. After this process, the balut products are then transported for selling in local markets.

Describing the various ways of balut consumption

Street foods are a significant part of the Filipino culture [ 26 ]. This may be attributed to the affordability and accessibility of such foods. Its cleanliness and safety may pose a concern, yet it remains popular in the market. Balut became popular as a ready to eat night time snack especially for those who would need some energizer or energy boost [ 18 ]. It is also believed that balut is eaten during the night to avoid seeing its hideous look. Accordingly, it is used to alleviate fatigue and sharpen one’s focus, especially for those working during graveyard shifts. It was also known as a pulutan or some sort of snack taken during street drinking sessions. Known to be nutritious, some also eat balut with the belief that it would strengthen their knees and contain some medicinal properties.

Traditionally, the consumption of balut was limited by eating it straight from its shell after it was boiled. The eggs are eaten by gently tapping the wider part of it to create a small opening where the consumer could sip the broth. A pinch of salt or vinegar may be put for a more savory taste. After that, the rest of the shell must be cracked open. The yolk and the embryo are then eaten together. It was also described to have an unusual texture. Most prefer not to eat the white part, which is the rock, since it is quite hard to eat. Some claim that eggs processed with a mechanical incubator does not taste as good as eggs incubated with rice since locals believe that the rice husks give balut a sweeter taste [ 7 ].

Although it seems that penoy are “rejects” of balut, local vendors were able to develop a variation of penoy and sell it in the market. Penoy na may sabaw contains a balut-like broth while penoy na tuyo is a lot similar with hard-boiled chicken eggs. When the penoy is starting to spoil, it will give off a strong sulfur smell when exposed to air. This type of egg is called abnoy or a colloquial term for abnormal. Although this seems that the egg has no use, some locals were able to use it as a main ingredient for a delicacy called bibingkang itlog . This is made by cooking the egg into a scrambled egg which is also called as a rotten egg omelet and sold by placing on a piece of banana leaf. Despite its rotten stinky smell, it is known to be delicious [ 40 ]. However, abnoy is rarely available in local markets. When it is past the balut stage, the chick comes to a state of rigor mortis or nearly about to hatch, called ukbo . It is when there is no yolk or white left but the almost-born chick only. After removed from its shell, this will be cooked in adobo style—seasoned with soy sauce and vinegar and then fried as well. These variations of how the duck eggs can be prepared and used show the ingenuity of Filipinos to make use of what they have and to avoid waste.

In Cubao, Quezon City, the process of making fried balut is believed to be where the industry started [ 4 ]. A vendor was unable to sell some of the balut since it has been incubated longer. To avoid economic losses, she decided to take the chick from the shell and roll them in flour before frying. Later on, the flour is replaced with an orange-colored batter. This street food became known as tokneneng . It is sold while placed on little bowls with some vinegar and salt. In another instance, male chicks are mostly discarded as they do not produce eggs. Then, a local decided to fry these day-old chicks wrapped in a similar orange-colored batter. These are usually sold by putting them inside plastic cups. It is commonly known as super chicks or day zero.

At present, balut is starting to gain recognition in the culinary world [ 19 ]. Like salted eggs, it is now being incorporated into several dishes and desserts. Sorpresa de balut or surprise is an appetizer served in restaurants that has balut seasoned with flour then fried or baked in a crust with some olive oil or butter. In addition, it has recently been used as a flavoring of a gelato. Accordingly, this presents a potential to increase the market for balut in the local and global setting.

It has been established that the process of making incubated eggs originated from China. Consequently, balut may be criticized as inauthentic and foreign to the Filipino culture because of the numerous similar preparations available in other countries. It is maodan in China, hot vit lon in Vietnam, and phog tea khon in Cambodia. The long history of influences brought by different cultures including Chinese, American, and Spanish also resulted in significant changes in the Filipino cuisine. Balut, along with other delicacies such as siomai, bistek (beef steak), and lechon has made its way to the diet of Filipinos. Instead of looking at balut as an inauthentic Filipino food, this emphasizes the shared culture of production and consumption of incubated eggs that can be found in several Asian countries.

The definition of authentic Filipino and Asian cuisine has been limited to what is indigenous [ 41 ]. With this definition, it was presumed that balut is not truly Filipino. However, the discovery of balut and its continuous patronage has allowed it to become more Filipino in various ways. Starting from the tedious process of traditional incubation, the magbabalut carefully ensures that each egg receives the proper amount of heat by placing them on makeshift baskets surrounded by bags of heated husks. Then, each egg is examined during the candling process and continuously incubated until it reaches the perfect 18-day incubated balut. The balut is made readily accessible everyday along the streets where the vendor carries them on baskets filled with sand to ensure its warmth until eaten. It is consumed by cracking one end, sipping its broth, and seasoning it with some vinegar or a pinch of salt. This unusual production and consumption of balut represents the creativity of Filipinos to make something similar with other Asian cultures yet uniquely Filipino. Balut gained its popularity as an affordable, nutritious, and ready-to eat snack that makes it a staple and favorite street food among Filipinos. It has long been embedded in the Filipino culture that it became equated with the Filipino identity. In some ways, it gives off the notion that anyone who cannot eat a balut is not considered a true Filipino [ 2 ]. The balut comes with a symbolic value in the construction of the Filipino identity and even a rite of passage for others [ 18 ]. Balut is able to transcend the notion of authentic Filipino food as indigenous and became a delicacy of its own. Its authenticity lies on its own uniqueness and the meaning that has been ascribed to it. Thus, it has been characterized as a cultural icon in the Philippines.

The balut industry of the Philippines has long been established, yet still remains underdeveloped. With inconsistent and low duck egg production and unstable demand in the market, the future of the balut industry is still uncertain. Headed by the Philippine Council for Agriculture, Aquatic and Natural Resources Research and Development of the Department of Science and Technology (DOST-PCAARRD), the Itik Pinas is an attempt to improve the local balut industry primarily by increasing the duck egg production. In an agricultural country like the Philippines, the vision of improving the status of the balut industry brings with it the hope of alleviating poverty primarily in the rural sector and the recognition of balut as an authentic Filipino food.

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Acknowledgements

This project acknowledges the support of the following institutions and individuals: Philippine Council for Agriculture, Aquatic and Natural Resources Research and Development of Department of Science and Technology (DOST-PCAARRD), Research Center for Social Sciences and Education of the University of Santo Tomas (UST-RCCSED), Reynaldo V. Ebora, Synan S. Baguio, Alfredo Ryenel M. Parungao, Prof. Maribel G. Nonato, Prof. Belinda V. de Castro, and Mr. Jeric Albela.

This project acknowledges the funding support of the following institutions and individuals: Philippine Council for Agriculture, Aquatic and Natural Resources Research and Development of Department of Science and Technology (DOST-PCAARRD) and Research Center for Social Sciences and Education of the University of Santo Tomas (UST-RCCSED). These institutions covered for the data collection and processing expenses for the project.

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MCPA designed the project structure (objectives, methods, analytical frame) and co-authored the “Introduction,” “Results,” and “Conclusion” sections. TIMDV co-authored the “Introduction,” “Results,” “Discussion,” and “Conclusion” sections. KPMC co-authored the “Results” and “Discussion” sections. All authors read and approved the final manuscript.

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Alejandria, M.C.P., De Vergara, T.I.M. & Colmenar, K.P.M. The authentic balut: history, culture, and economy of a Philippine food icon. J. Ethn. Food 6 , 16 (2019). https://doi.org/10.1186/s42779-019-0020-8

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Breakfast in the Philippines: food and diet quality as analyzed from the 2018 Expanded National Nutrition Survey

  • Imelda Angeles-Agdeppa   ORCID: orcid.org/0000-0001-9132-7399 1 ,
  • Ma. Rosel S. Custodio 1 &
  • Marvin B. Toledo 1  

Nutrition Journal volume  21 , Article number:  52 ( 2022 ) Cite this article

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Metrics details

The quality of foods taken during breakfast could contribute in shaping diet quality. This study determined the regularity of breakfast consumption and breakfast quality based on the food, energy and nutrient intakes of Filipinos.

Materials and methods

Data from the 2018 Expanded National Nutrition Survey (ENNS) was extracted for analysis. There were 63,655 individuals comprising about 14,013 school-aged children (6–12 years old), 9,082 adolescents (13–18 years old), 32,255 adults (19–59 years old), and 8,305 elderly (60 years old and above). Two-day non-consecutive 24-h food recalls were used to measure food and nutrient intakes. Diet quality was measured using Nutrient-Rich Food Index (NRF) 9.3. The sample was stratified by age group and NRF9.3 tertiles.

Results and findings

Results showed that 96 – 98% Filipinos across age groups were consuming breakfast. Children age 6–12 years have the highest NRF9.3 average score (417), followed by the elderly (347), adolescents (340), and adults (330). These scores were very low in comparison with the maximum possible NRF score which is 900. The essential nutrient intakes of respondents were significantly higher among those with the healthiest breakfast diet (Tertile 3) compared to those with the poorest breakfast diet (Tertile 1). However, participants in the healthiest breakfast diet did not meet 20% of the recommendations for calcium, fiber, vitamin C, and potassium.

Conclusion and recommendations

This study revealed that majority of the population are regular breakfast consumers. However, the breakfast consumed regularly by Filipinos were found to be nutritionally inadequate. And even those classified under Tertile 3 which were assumed as having a better quality of breakfast were still found to have nutrient inadequacies. Thus, the study suggests that Filipinos must consume a healthy breakfast by including nutrient-dense foods such as fruits, vegetables, whole grains, fresh meat, and milk to provide at least 20–25% of the daily energy and nutrient intakes.

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Introduction

Breakfast is often regarded as the most important meal of the day. The American Heart Association defines breakfast as the first meal of the day eaten within 2 h after waking up [ 1 ]. Latest evidences from previous studies suggest consuming about 15 – 25% of the daily energy intake at breakfast [ 2 ], wherein the composition of the foods consumed should be from the five main food groups such as: Starchy foods, fruits and vegetables, milk and dairy, protein sources and low-fat spreads and oils. Other recommendations from nutrition and dietetics institutes suggest that breakfast consumption is a key component to an optimal diet which improves cognitive function and helps control against weight gain [ 3 , 4 ]. It was also found that a breakfast high in protein and fat proves to aid in the management of glycemic index among type 2 diabetics [ 5 ]. The International Breakfast Research Initiative (IBRI) aimed to develop nutritional guidelines for a healthy breakfast by conducting a standardized study of national nutrition surveys from selected Asian countries [ 6 ].

Throughout the years, a significant amount of literature has supported the beneficial effects of breakfast consumption. Several studies have consistently recorded a broad variance in breakfast’s contribution to nutrient intake and diet quality in different parts of the world [ 7 , 8 , 9 ]. Daily breakfast intake was correlated with higher intakes of healthier foods such as whole grains, dairy, and vegetables, thus giving breakfast consumers a higher tendency to achieve recommended nutrient intakes [ 10 ]. In adolescents, there is a reduced risk of becoming overweight or obese [ 12 13 ]. In terms of mental health, it was found out that breakfast consumers were less likely to be emotionally distressed, have lower risk of depression and perceived stress compared to its opposite counterpart [ 14 ].

In the Philippines, there is limited information about breakfast consumption.

A typical Filipino diet in a day consists of about three and a half (3 ½) cups of cooked rice, one (1) matchbox of fried fish, and half (1/2) cup of boiled vegetables per day and these are usually consumed during the three (3) major meals of the day: breakfast, lunch and supper []. Previous studies found that breakfast food pattern in the Philippines and specific provinces was rice, bread, fish, egg, and coffee which were mainly composed of foods rich in carbohydrates, protein, and fat [ 16 17 ]. It was noticeable that the regular breakfast of Filipinos was lacking in vitamins and minerals which are commonly found in fruits and vegetables. In a study with 45 severely wasted children, the respondents “always” eat their lunch and dinner at home and “sometimes” only for breakfast and after the school feeding program was implemented, the respondents' nutritional status significantly improved to normal [ 18 ]. Research has pointed out that nutrients that are unattained during breakfast are not compensated by meals in the later day, thus stressing the importance of breakfast consumption in meeting daily nutrient requirement [ 19 ]. The overarching objective of this study determined the regularity of breakfast consumption and breakfast quality based on the food, energy and nutrient intakes of Filipinos.

Methodology

Study population.

For this study, data was derived from the 2018 Expanded National Nutrition Survey (ENNS) dietary component survey. The coverage population of the ENNS is about 40 provinces with over 80,540 surveyed individuals with a response rate of 81.5%. The 2018 ENNS utilized the 2013 Master Sample List developed by the Philippine Statistics Authority (PSA). This sampling design followed a two-stage cluster sampling technique. The first stage involved the selection of Primary Sampling Units (PSUs), which involved sampling domains from 81 provinces, wherein 16 sample replicates was drawn from each domain. The second stage involved the selection of households from the 16 sample replicates. During this stage, the selected households served as the final sampling unit [ 20 ]. The final sample size that is included in this study was n  = 63,655. The breakdown per age of the total sample size are as follows: 14,013 school-aged children (6–12 years old), 9,082 Adolescents (13–18 years old), 32,255 Adults (19–59 years old), and 8,305 Elderly (60 years old and above) Fig.  1 .

figure 1

Flowchart for sample selection. Data from the 2018 ENNS was used with a starting sample size of 76,325. After exclusion of participants and checking of completeness of the data, final participants included in the study is 63,655

Breakfast regularity and dietary data

Breakfast was defined based on the meal code number 1 indicated in the questionnaire which was self-reported as “Breakfast” by the interviewee. On the other hand, breakfast skipping was defined in this study as no breakfast consumption or less than 50 kcals of energy consumed at breakfast otherwise regular consumer if more than or had 50 kcal [ 10 ]. Two day non-consecutive 24-h dietary recalls were done face-to-face with each participant or child's parent or caregiver. The interviews were conducted by trained registered dietitians during home visits using a prepared questionnaire. The initial 24 h dietary recall was collected for all respondents, and a second 24 h dietary recall was completed in 50% of randomly selected households only on a non-consecutive day to estimate the day-to-day variation component in energy and nutrient consumption necessary for habitual intake analysis. The second 24 h dietary recall was generally obtained 2 days after the first 24 h recall. Food records were encoded and estimated energy and nutrient intakes were processed using the electronic–based Individual Dietary Evaluation System (IDES) developed by the Institute. This system contains the data of the updated Filipino Food Composition Tables (FCT) [ 21 ].

NRF9.3 scoring of breakfast consumption

Diet quality was measured using the Nutrient Rich Food Index (NRF) 9.3. The NRF9.3 is a validated measurement tool to determine the nutrient density of the total diet. The determination of the nutrient density score for the NRF 9.3 is calculated by the sum of the percentage daily reference values (DRVs) of the nine nutrients that are recommended (protein, dietary fiber, vitamin A, C, and D, calcium, iron, potassium, and magnesium) minus the sum of the percentage of DRVs for the three nutrients to limit (added sugar, saturated fat, and sodium). Total sugar intake was used since added sugar was not included in the survey. The closer the value is to the maximum score of 900 would indicate better quality of the overall diet. The basis for the NRF9.3 algorithm was from a nutrient profiling model on linking food items that have the highest nutrient density at the same time, affordable and engaging [ 20 , 22 , 23 ].

The Philippine Dietary Reference Intake (PDRI) and other standard recommendations were used to calculate the reference daily values (DVs) []. The following were the qualifying nutrients and standard reference amounts: protein (50 g), fiber (25 g), vitamin A (1500 RE), vitamin C (60 mg), vitamin D (10 mcg), calcium (1000 mg), iron (18 mg), potassium (3500 mg) and magnesium (400 mg). The 3 disqualifying nutrients and maximum recommended values (MRVs) were: added sugar (50 g), saturated fat (20 g) and sodium (2400 mg).

The following is the NRF 9.3 calculation formula:

where intake i is the intake of each nutrient, ED is the energy density, and DV i is the reference daily value for that nutrient. In NR calculation, the intake of each nutrient for each subject was normalized for 2000 kcal and expressed as a percentage of the reference DVs. Previously, nutritional % DVs were capped at 100, so that an extremely high intake of one nutrient could not compensate for a dietary deficiency of another. Only the portion in excess of the recommended quantity was taken into account for the LIM.

Commonly consumed food at breakfast

Food group consumption was express as actual intake (in grams) and percentage of consumer. Consumers of each food group were scored 1 if they consumed at least 10 g otherwise 0 (< 10 g) [ 27 ]. Only the top 10 mostly consumed food groups were presented in this study.

Contribution of breakfast to the daily intake and recommendation

The percentage contribution of breakfast to daily nutrient intake was calculated by calculating the total intake of each nutrient at breakfast divided by the total intake of each nutrient at daily intake multiplied by 100. The percentage contribution of breakfast among people with the healthiest breakfast quality to the daily recommendation was calculated by dividing their intake to the recommendation for each nutrient and their respective recommendations and then multiplied by 100. Same calculation was done for the percentage contribution of nutrient intake from all meals to daily recommendation.

Outlier determination

Quality control of the dietary intake data was conducted in two steps. In the first step, the foods reported by a participant like coding information, and quantity were reviewed. In the second step, scatterplots and histograms was used to determine the outliers of the datasets. For implausible micronutrient intake, excessive intakes were defined as those that exceeded 1.5 times of the 99th percentile of the observed intake distribution of the nutrient in the corresponding sex, and age group. Intakes above the upper limit were substituted by a random value generated from a uniform distribution in the intervals with lower bound equal to the 95th percentile of the observed intake and an upper bound equal to 1.5 times the 99th percentile [ 28 ]. After validation and checking for completeness, a total of 12,670 participants were excluded in this study. This included pregnant mothers, lactating mothers, children 5 years old and below, and outliers.2.3. Measurement of Diet Quality.

Statistical analysis

PCSIDE version 1.02 (Iowa State University, Ames, IA, USA) was utilized in estimating the usual nutrient intakes at breakfast. This program estimates distributions of usual nutrient intake by removing the effect of day-to-day (intra-person) variability in intake from daily intakes [ 29 , 30 ]. All statistical analyses were performed in the STATA version 15 (StataCorp, USA) software. Analysis of variance (ANOVA) was used to test the mean difference of NRF 9.3 scores, energy and nutrients intakes between age groups. Differences in food group consumption were tested using Analysis of Covariance (ANCOVA), adjusted for energy at breakfast as well as sociodemographic characteristics. NRF9.3 score were group into tertiles using –xtile- command in STATA, where, Tertile 1 represent the group with the poorest breakfast quality and Tertile 3 have the healthiest breakfast quality. A trend test was conducted to test whether nutrient intakes at breakfast tends to either increase or decrease across NFR tertiles. Chi-square test was conducted to test the association between consumption of food group and NRF 9.3 Score in tertiles. To achieve estimates at a population level, weighting recommendations was followed in all analyses using “svy” command. The significance level was set at p  < 0.05.

Breakfast regularity across participants’ characteristics

Table 1 shows that 96–98% are breakfast consumers. Only 2% of the younger age groups (6–12 yo and 13–18 yo) were breakfast skippers while for both adults and elderly groups, the percentage slightly increased to 4%. Almost all participants were breakfast consumers across demographic characteristics and nutritional statuses (male 95–98%, female 96–98%). There was a significant association between breakfast consumption and gender among adults only. Proportion of female breakfast consumers (96%) was higher compared to males (95%). In contrast to urban areas, higher percentage of breakfast skippers were significantly observed in rural areas among adolescents (2.3%), adults (4.7%) and elderly (4.8%) groups. It appears that proportions of breakfast consumers across wealth quintile was almost equivalent for all age groups. Educational attainment was significantly associated to breakfast consumption among adults and elderly group. For adults, the proportion of breakfast consumers who have an elementary and college level education was 94% and 97%, respectively. On the other hand, the proportion of breakfast consumers among the elderly with elementary level and college level education was 95% and 98%, respectively. Nutritional status of the children and adolescents was not associated to breakfast status. Elderly with chronic energy deficiency (CED) (94%) has the lowest proportion of breakfast consumers (94%), while overweight (97%) and obese (98%) elderly has the highest proportion of breakfast consumers.

Consumption of commonly consumed food at breakfast by NRF9.3 tertiles

Tables 2 , 3 , 4 and 5 presents the average consumption of the top 10 mostly consumed food groups. The NFR 9.3 tertiles are also shown for the age groups including the percentage consumption of each food group. The analyses showed that consumption of all top 10 food groups were associated to NRF tertiles. The highlight of this result explains that individuals with the Tertile 3 consumed more vegetables, fresh meat and fish, and eggs but less in rice, sugar and coffee.

In Table 2 , children with poorest quality diets (Tertile 1) have a higher percentage consumption of cereal products (51%) and sugars (27%) while having lower consumption of powdered milk (11%), other vegetables (2%), green leafy vegetables (0.4%), fresh fish (2%), chicken eggs (6%), cacao and chocolate-based beverages (1%), and rice (49%). For adolescent group in Table 3 , results show that Tertile 1 has a higher percentage consumption of coffee (57%), sugars (30%), and cereals products (52%) while having the lowest percentage consumption of green leafy vegetables (0.4%), other vegetables (3%), cacao and chocolate-based beverages (0.3%), chicken egg (6%), fresh fish (2%), and rice (43%) compared to T2 and T3. Consumption of coffee seems to increase as age increases with tertile 1 having the highest consumption including sugars. This is evident in the analysis for the adults and elderly group. In Table 4 , results showed that adults aged 19–59 years old in Tertile 1 has the highest percentage consumption of coffee (85%), and cereal products (47%), while having the lowest percentage consumption of green leafy vegetables (0.4%), other vegetables (2%), and chicken egg (7%), fresh fish (2%), fresh meat (1%) and rice (29%) compared to T2 and T3. On the other hand, results shown in Table 5 for the elderly group aged 60 years old and above shows that Tertile 1 has the highest percentage consumption of coffee (88%), and cereal products (48%) while having the lowest percentage consumption of green leafy vegetables (0.4%), other vegetables (2%), powdered milk (3%), chicken egg (8%), fresh fish (3%), and rice (29%) compared to T2 and T3. For all age groups, Tertile 3 has the highest mean consumption of fresh fish, green leafy vegetables and other vegetables while having a moderate consumption of rice, chicken egg, and cooking oil. Younger age groups such as school age children and adolescents who belong to T3 had the highest consumption of chocolate-based beverages. While older adults and elderly in T3 had the highest consumption of rice and the least consumption of coffee.

Usual energy and nutrient intakes at breakfast and NRF9.3 scores by age group

Table 6 presents the average NRF 9.3 scores and mean habitual intake of energy and nutrients at breakfast per age group. Children age 6–12 years has the highest NRF 9.3 average score with 417 which reflects to a healthier diet at breakfast compared to elderly with 347, adolescent (340) and also for adult (330) age groups which had the lowest scores. In all the age groups, breakfast contributed approximately 328 kcal to 440 kcal of their daily intake with the significant highest mean intakes of energy among adolescents (440 kcal) and adults (426 kcal). In terms of macronutrients, the highest mean intakes for total carbohydrates at breakfast were significantly observed among adults (77 g) followed by adolescents (77 g), elderly (64 g) and lastly, school-aged children (54 g). Mean protein intakes were also considerably highest in adolescents (13 g) and lowest in children (10 g). This similar trend is also observed with other nutrients such as fiber, niacin, vitamin D, magnesium, and potassium. With regards to total fat, saturated fat, monounsaturated fat (MUFA), polyunsaturated fat (PUFA), cholesterol, sodium, and iron, mean intakes were significantly highest among adolescents and lowest in the elderly. Highest mean intakes of total sugar and calcium were seen among the elderly while vitamin A intake was significantly higher among adults.

Usual energy and nutrient intakes at breakfast by NRF9.3 tertiles

Tables 7 , 8 , 9 and 10 showed the mean intake of usual energy and nutrients across NRF9.3 tertiles. In Table 7 , results showed cumulative trend of energy intake at breakfast across NRF9.3 tertiles. There was a significant trend in all nutrients across NRF9.3 tertiles at breakfast among children except for total fat and saturated fat. Also, increasing consumption were observed across NRF9.3 tertiles for energy, protein, carbohydrates, fiber, thiamin, riboflavin, niacin, vitamin C, vitamin A, vitamin D, calcium, phosphorus, iron, magnesium, potassium, and cholesterol, while a decreasing trend was seen for MUFA, PUFA, total sugar and sodium intake. In Table 8 , consumption of all nutrients among adolescents showed significant trends including energy intake. Moreover, consumption of total fat, saturated fat, MUFA, PUFA, total sugar and sodium declined across NFR tertiles while other nutrients significantly increased. For adults and elderly groups in Tables 9 and 10 , both groups had the same results which was all nutrients including energy intake showed significant increasing trends across NRF tertiles. Total sugar and sodium intake decreases from tertile 1 to tertile 3. Results emphasize that the consumption of the population group in Tertile 3 consumed more essential nutrients such as vitamins and minerals and less intake of sodium, total sugar and total fat.

Contribution of energy and nutrients at breakfast to the total daily intake

Figure  2 shows the energy and nutrient contribution of breakfast to the total daily intake. Breakfast must consist at least 20–25% of the total daily energy and nutrients. Overall, energy and nutrients coming from breakfast reached more than the 20% of the total daily intake of energy and nutrients. On the other hand, total sugar, cholesterol, and sodium contributed to more than 30% at breakfast for all age groups. Total sugar accounted for 40% of daily consumption at breakfast for adults aged 19–49 years old and goes up to approximately 45% for the elderly. Contribution of vitamin C at breakfast seems to be low especially for adults aged 19–59 years old which means that vitamin C intake was low during breakfast.

figure 2

Energy and nutrient contribution of breakfast to the total daily intake. *PUFA stands for polyunsaturated fatty acids, MUFA stands for Monounsaturated fatty acids, SatFat stands for saturated fatty acids. The 20% cutoff is indicated by a vertical line with color green bar

Contribution of breakfast to the daily recommended intakes

Figure  3 showed that children with the healthiest breakfast diets met the 20% recommendation for intake of protein (32%), iron (24%), vitamin D (22%), vitamin A (31%) and magnesium (37%) but fall short in energy (19%), calcium (14%), fiber (7%), vitamin C (17%) and potassium (14%) intakes at breakfast. On a daily basis, intake of magnesium and protein were more than adequate but there were deficiencies in calcium, fiber, iron, vitamin D, vitamin C, and potassium. There were no recorded excessive intakes of total sugar, saturated fat, and sodium intake at breakfast, same was observed in the results for daily consumption. Results also showed that there is a low nutrient consumption at breakfast.

figure 3

Contribution of breakfast to the daily recommendation among children NOTE: Daily Intake = All meals; Intake at breakfast of healthiest individuals = intake from breakfast only of participants that were categorized in Tertile 3 which represent the individual with healthiest diet; 20% Benchmark = 20% of the recommended intake of each nutrient (based on the PDRI), 100% Benchmark = the total recommendation per day

Adolescents with the healthiest breakfast diets met the 20% recommended intake of protein (26%), vitamin D (29%), vitamin A (22%) and magnesium (24%). Only 7% of fiber at breakfast was consumed. Poor intakes of calcium (12%), iron (15%), and vitamin C (12%) were observed at breakfast for adolescents. There is a slightly low contribution (11%) of total sugar, saturated fat (17%), and sodium (13%) for this group. Overall, it is noticeable that most micronutrients were inadequate especially calcium, fiber and vitamin C (Fig.  4 ).

figure 4

Contribution of breakfast to the daily recommendation among adolescent. NOTE: Daily Intake = 24 h food recall (All meals); Intake at breakfast of healthiest individuals = intake from breakfast only of participants that were categorized in Tertile 3 which represent the individual with healthiest diet; 20% Benchmark = 20% of the recommended intake of each nutrient (based on the PDRI), 100% Benchmark = the total recommendation per day

Adults with the healthiest breakfast diets (Tertile 3) were adequate in energy (23%), protein (27%), iron (20%), vitamin D (28%), vitamin A (20%), potassium (23%) and magnesium (28%) at breakfast. However, contribution of calcium (17%), vitamin C (12%), and fiber (9%) at breakfast is low, which is an unceasing problem up until this age group (Fig.  5 ).

figure 5

Contribution of breakfast to the daily recommendation among adults. NOTE: Daily Intake = 24 h food recall (All meals); Intake at breakfast of healthiest individuals = intake from breakfast only of participants that were categorized in Tertile 3 which represent the individual with healthiest diet; 20% Benchmark = 20% of the recommended intake of each nutrient (based on the PDRI), 100% Benchmark = the total recommendation per day

Among the elderly with the healthiest breakfast diets, their breakfast consumption reached more than the 20% recommended intake of energy (21%), protein (21%), iron (23%), and magnesium (23%). However, the composition of their breakfast was inadequate in fiber (10%), vitamin D (9%), vitamin C (15%), and calcium (17%). There was only 1% excessiveness of total sugar (21%), and no excessiveness of saturated fat and sodium. On a daily basis, they were inadequate of calcium, fiber, vitamin D, and vitamin C (Fig.  6 ).

figure 6

Contribution of breakfast to the daily recommendation among elderly. NOTE: Daily Intake = 24 h food recall (All meals); Intake at breakfast of healthiest individuals = intake from breakfast only of participants that were categorized in Tertile 3 which represent the individual with healthiest diet; 20% Benchmark = 20% of the recommended intake of each nutrient (based on the PDRI), 100% Benchmark = the total recommendation per day

The present study determined the regularity of breakfast consumption and its contribution to the daily energy and nutrient intakes of Filipinos in order to serve as basis for breakfast recommendations in the Philippines. To our knowledge, the present study was probably the first attempting to describe the breakfast consumption of Filipinos. With the use of the secondary data from the 2018 ENNS gathered by the DOST-FNRI, this study was able to analyze the breakfast intakes of Filipinos [ 21 ]. Although the initial objective of the IBRI consortium was to pull together breakfast studies in Southeast Asia to come up with a prevailing unified recommendation for the region, this has been proven a challenge because of the varied breakfast definitions across countries, the different meal occasions, and the variety of food groups consumed at breakfast. Hence, the breakfast profile of Filipinos remained as the immediate topic of investigation in this study.

Breakfast regularity

Results from the analysis reported that majority of the Filipino population (96-98%) regularly consume breakfast. This strongly identifies that breakfast is an important meal for Filipinos. As stated in a previous literature, the regularity of breakfast consumption and meal times were closely related to healthy lifestyle habits and could play an important role in providing adequate nutrients [ 31 , 32 , 33 ].

Commonly consumed food and nutrient intakes at breakfast in relation to diet quality

In terms of breakfast energy and nutrient intakes, the present analyses also allowed this study to identify food choices and breakfast patterns that were associated with the highest quality of breakfast diets, as captured by NRF 9.3 scores. Participants were divided into tertiles based on their NRF 9.3 scores for each age group to investigate the associations between breakfast nutrient intake and overall diet quality. The age groups with the highest NRF 9.3 score or Tertile 3 (group with the healthiest breakfast) were characterized in this study to consume higher amounts of essential nutrients and more diversified diets as per food groups consumption, compared to lower tertiles. Moreover, a higher NRF score was associated with a higher consumption of desirable food groups making the index an ideal measurement of overall diet quality.

Upon analysis, the current study reported that energy intakes at breakfast does differ across NRF 9.3 tertiles. More so, it was revealed that Filipino children aged 6–12 years had the highest NRF average scores (417), followed by elderly (347), adolescents (340), and adults (330). Yet, all these scores were still considered to be very low in comparison with the maximum possible NRF score which is 900; and if compared with the findings from previous IBRI studies conducted in Western countries [ 7 , 10 ]. These results show that majority of the Filipinos regularly consume breakfast, yet the breakfasts they were consuming reflected a meal of poor diet quality as per NFR 9.3 scores.

Filipino children and adolescents with the healthiest breakfast diets (Tertile 3) were associated with higher intakes of energy, total protein, total carbohydrates, total fiber, and micronutrients (except total sugar and sodium) compared to counterparts (Tertile 1 and Tertile 2). While for Filipino adults and elderly, those consuming the healthiest quality of breakfast diet exhibited higher intakes of energy, total protein, total carbohydrates, total fat, MUFA, PUFA, total fiber, micronutrients (except total sugar and sodium), and cholesterol. Even so, participants classified under the group with the healthiest diet (Tertile 3) still did not meet 20% of the dietary recommendations for calcium, fiber, vitamin C, and potassium, which clearly represents an opportunity for needed improvement.

These results were reflected in the breakfast consumption of food groups as higher intakes of fresh fish, chicken egg, fresh meat, green leafy vegetables and other vegetables, and lower intakes of rice, coffee, sugars, and other cereal products were found among groups with the healthiest breakfast diet. These food groups are included in the 2012 Nutritional Guidelines for Filipinos (NGF) which reflects the impact of its consumption towards a healthier diet [ 34 ]. The current study suggests that healthier food patterns at breakfast could be further examined in order to identify key food patterns in relation to nutrient intakes [ 35 ]. It was also found that the composition of breakfast among the healthiest individuals were similar to the recommended food groups to be consumed as stated in the Pinggang Pinoy Guidelines [ 36 ].

The investigation for the main sources of these aforementioned nutrients that Filipinos were found to be inadequate had revealed that the food groups that were associated as the richest sources of these nutrients were not consumed at breakfast. According to the food consumption survey, vitamin C intakes in the Philippines had an 83%-95% inadequacy rate which is very alarming [ 10 ]. This is reflected on the low levels of fruit and vegetable consumption at breakfast among Filipinos which are abundant sources of vitamin C, dietary fiber, and potassium []. Moreover, the survey also reported that most of the calcium intake came from rice (17–23%) which may not provide rich amounts of calcium as compared to milk and dairy products [ 38 ]. Previous literatures have pointed that low dietary intake of calcium and fiber may be a significant risk factor for obesity, thus increasing the risk for those who have inadequate calcium and fiber intakes [ 39 40 ]. Ingestion of a certain amount of dietary fiber apart from alleviating constipation also reduces hunger, thereby reducing total energy intake and preventing weight gain [ 40 ]. Additionally, prior research stated that low vitamin C intakes may put people at risk of developing clinical scurvy, which is fatal if left untreated [ 41 ] and low potassium intakes increase the risk of people for hypertension and other cardiovascular diseases [ 42 ]. Lower sodium and sugar intakes were also observed among Filipinos with the healthiest diet quality (tertile 3). Findings from previous literatures reported the impact of dietary sodium and sugar intake to cardiovascular disease risk, which recommends that lower sodium and sugar intakes should be encouraged to prevent the onset of heart diseases [ 43 ].

Contribution of breakfast to daily intakes

Among Filipino breakfast consumers, more than 20% of the total daily energy intake was from breakfast. This finding is in line with a previous breakfast study conducted in Denmark [ 35 ], which indicates a relatively staple contribution of breakfast to the total energy intake. Moreover, the definition of nutrient density in the 2005 Dietary Guidelines defined nutrient-dense foods as those containing “more nutrients than calories” [ 45 ]. Thus, based on a simple nutrients-to-energy ratio, breakfast can be considered as a nutrient-rich meal. In contrast, breakfast contributed more than 30% of the daily intakes for total sugar, cholesterol, and sodium, which were higher than the contribution of energy and other micronutrients to the daily diet. It was also worth to note that vitamin C was poorly consumed during breakfast which is alarming, since breakfast meals have a huge impact to one’s daily nutrient intake. A vast majority of previous studies showed a clear overall nutritional benefit of consuming breakfast in respect of the key nutrients of public health importance in many countries [ 7 , 10 , 35 , 46 ].

Indeed, results in this study had revealed that emphasis should be given on the consumption of fruits, vegetables, milk, and fresh meat which were among the least consumed food groups during breakfast among the Filipino population. Yet, it is also alarming that fruits as well as milk and milk products were found further down the list of mostly consumed food groups among Filipinos. When considered together, the poor food choices at breakfast are likely contributing to the suboptimal intake of some nutrients at this meal (e.g. high contribution of added sugar, and low contribution to vitamin C, fiber, potassium intakes) [], which could be improved by the higher consumption of fruits, vegetables, fresh fish, fresh meat, and milk, and lower consumption of refined grains, coffee and sugary products.

Limitations of the study

Datasets for the food recalls did not record whether the food recalls were on a weekday or weekend. With the large sample size used in this study, this consideration could already be factored-in. The usage of dietary supplements was not included in this study since the goal was to estimate nutrient intakes through food and beverages only. This might result in an underestimate of total daily micronutrient consumption.

This study revealed that majority of the population are regular breakfast consumers. However, the breakfast consumed by Filipinos were found to be of poor quality. And even those classified under tertile 3 which were assumed as having a better quality of breakfast were still found to have nutrient inadequacies. Based on the findings obtained, it could be suggested that Filipinos must consume a healthy breakfast by including nutrient-dense foods such as fruits, vegetables, whole grains, fresh meat, and milk to provide at least 20–25% of the daily energy and nutrient intakes. The results from this study also provide strong evidence for a positive impact of breakfast consumption on overall diet quality. These findings could help to inform the development of nutrient-based recommendations for a balanced breakfast for the first time in the Philippines.

The findings of this study opened a window of opportunity in improving the diet quality of breakfast in the Philippines by re-emphasizing recommendations in the Pinggang Pinoy and on the consumption of nutrient-dense foods. A future favorable turnout of the study would be the expansion of the national feeding program with the inclusion of breakfast and the possibility of extending the feeding until the adolescent age. As per Republic Act 11,037, which is the signed law that enacts free meals at public schools for undernourished kids, the current national nutrition program partnered by the Department of Education (DepEd) and Department of Social Welfare and Development (DSWD) only provides lunch meals to preschool until elementary children. Expansion from breakfast to lunch and targeting up until the adolescent age may help in mitigating micronutrient deficiencies through age groups, since breakfast is consumed by majority of the population.

Availability of data and materials

Publicly available data from the 2018 Expanded National Nutrition Survey by the Food and Nutrition Research Institute – Department of Science and Technology is available at http://enutrition.fnri.dost.gov.ph/ . Raw data sets are available on request from the corresponding author.

Abbreviations

National Nutrition

Nutrient Rich Food

International Breakfast Research Initiative

Department of Science and Technology – Food and Nutrition Research Institute

Philippines Statistics Authority

Primary Sampling Unit

Individual Dietary Evaluation System

Food Composition Table

International Network of Food Data System

Daily Reference Value

Recommended Dietary Intake

Philippines Recommended Dietary Intake

Institute of Medicine

National Cholesterol Education Program

Analysis of Variance

Analysis of Covariance

Chronic Energy Deficiency

Nutritional Assessment and Monitoring Division

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Acknowledgements

We would like to acknowledge the valuable efforts of the Nutritional Assessment and Monitoring Division (NAMD) for their responsibility in conducting the national surveys and ensuring the integrity of the collected data. We would also like to acknowledge Gabriel Masset and Mike Gibney for their critical inputs in this research, and Jezreel Ann Zamora for her assistance in the revision and finalization of the manuscript.

This research was funded by CEREAL PARTNERS WORLDWIDE, through the context of the International Breakfast Research Initiative – ASIA study. The APC was funded by the same company. The design, data collection, analysis and write-up of research study are solely done by the Authors.

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Imelda Angeles-Agdeppa designed the study and analysis, drafted the manuscript, and had the final responsibility for the contents. Ma. Rosel S. Custodio assisted in the analysis, interpreted the data, edited the manuscript, and held responsibility also for the contents. Marvin B. Toledo validated, analyzed, and interpreted the data and is responsible for the results of the study. The author(s) read and approved the final manuscript.

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The study was conducted according to the guidelines of the Declaration of Helsinki, and was reviewed by the Food and Nutrition Research Institute Institutional Ethics Review Committee with the protocol code FIERC2020018 dated November 4, 2020. The review board committee granted Exemption from Review of the study on December 3, 2020 based on the criteria of exemption as stipulated under provision 3.1 page 39 in the National Ethical Guidelines for Health and Health-related Research 2017, since the study involved “Protocols that involve the use of publicly available data or information”. Informed consent was obtained from all participants involved in the 2018 Expanded National Nutrition Survey by the Food and Nutrition Research Institute prior to their participation in the survey and collection of data.

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Supplementary Information

Additional file 1:.

Table S1. Age- and sex- specific reference daily values for young age group used for the calculation of NRF 9.3.  Table S2. Age- and sex- specific reference daily values for adult age group used for the calculation of NRF 9.3.

Additional file 2:

  Table S3. Food Group Classification.

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Angeles-Agdeppa, I., Custodio, M.S. & Toledo, M.B. Breakfast in the Philippines: food and diet quality as analyzed from the 2018 Expanded National Nutrition Survey. Nutr J 21 , 52 (2022). https://doi.org/10.1186/s12937-022-00804-x

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DOI : https://doi.org/10.1186/s12937-022-00804-x

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Food Sources and Nutrient Intakes of Filipino Working Adults

Nutrition is an integral part of economic development, since it influences workers’ health and productivity. This study evaluated the usual nutrient intakes and food sources of working adults. We conducted a cross-sectional survey that involved 1264 selected working adults aged 19 to 59 years old from randomly selected job sectors. Quantitative dietary data was collected by a 2-day, non-consecutive 24 h recall, while a dietary diversity questionnaire was used to assess the types and frequency of foods consumed. Physical activity was measured using the World Health Organization global physical assessment questionnaire. The prevalence of inadequate intakes, defined as the percentage of adults with intakes less than the estimated average requirements (EAR) or acceptable macronutrient distribution ranges (AMDR) were estimated using the PC—Software for Intake Distribution Estimation (PC-SIDE) program. The mean daily energy intake of working adults was 1768 kcal/day or 74% of the Estimated Energy Requirements (EER) for this age group. The percentage contribution to the total energy of fats (58%) and proteins (34%) were excessively high. Consumption of fruits and vegetables was only 30% and 40% of the recommended nutrient intake, respectively. Salt intake was 52% above the adequate intake. Nutrient inadequacy was high in almost all nutrients, including iron (99%), folate (97.9%), riboflavin (95.8%), calcium (94.7%), vitamin C (87.3%), and thiamin (76.6%). The top five food sources of energy included rice (35.6%), pork (15.1%), fats and oils (4.7%), chicken (4.4%), and bread (3.8%). Energy and nutrient intakes of working adults is extremely sub-optimal due to the consumption of few nutrient-dense foods. This may pose a triple burden of malnutrition if left unsolved.

1. Background

Nutrition is a fundamental right in nation-building. The World Health Organization (WHO) has emphasized that one of the basic human rights is freedom from hunger and malnutrition, which are prerequisites for human and national development [ 1 ]. This challenge is posed for every developing nation to provide optimum nutrition to its workers who are considered the lifeblood of the economy, since nutrition influences workers’ health and productivity [ 2 ]. A recently published report by the World Bank Organization estimated that the economic costs of undernutrition in terms of lost national productivity and economic growth ranged from around 2% to 3% of the Gross Domestic Product (GDP), and up to 11% of the GDP in Africa and Asia [ 3 ]. Moreover, mortality caused by non-communicable diseases continue to rise with an average of 41 million deaths each year globally, mostly among the ages of 30 to 69 years old in low- and middle-income countries (LMIC) which are deemed as lives lost prematurely [ 4 ]. Preliminary data published by the World Economic Forum in 2011 estimated that economic output loss from NCDs, such as diabetes, heart disease, cancer, and COPD may amount to US $47 trillion in two decades [ 5 ]. Other research has also pointed out hindrances to the productivity of workers, such as obesity [ 6 , 7 ] and micronutrient deficiencies, such as iron deficiency anemia [ 8 ]. Furthermore, the Global Burden of Disease in 2017 reported that there was a 45.8% increase in the prevalence of diabetes as a top cause of years lived with disability in the Philippines as compared to the 2007 data. Likewise, risk factors most associated with disability and death in the Philippines are usually attributed to dietary factors (27.1%) [ 9 ].

The Philippines has experienced a rise in the prevalence of overweight/obesity from 26.6% in the 2008 National Nutrition Survey to 37.2% in 2018, reflecting a 10.6% increase over a span of 10 years among adults 20–59 years old. Anemia among women of reproductive age was 11.6%, and the prevalence of vitamin D deficiency among 20- to 39-year-old Filipino adults was 55.5% [ 10 , 11 ]. Unhealthy lifestyle behaviors, such as smoking (20.7%), binge drinking (55.7%), and physical inactivity (40.6%) have been defined as great challenges besetting the adult Filipino population [ 12 , 13 , 14 ].

Generally, lack of access to healthy foods is cited as one of the main barriers to a healthy diet in the workplace. It has been postulated that poor diet on the job, resulting in either undernutrition or overweight and obesity, is causing a loss in productivity of up to 20% [ 14 ]. Other risk factors include socio-demographic educational level and income or lifestyle factors, which have been associated with an unhealthy diet [ 15 ]. Since 62.1% of the Filipino population (15 years old and over) are in the labor force [ 16 ], there is a crucial need to consider programs and interventions that could improve workers’ nutritional status and healthy lifestyle practices for higher productivity and reduce the risks of adults experiencing the triple burden of malnutrition—such as under-nutrition, over-nutrition, and micronutrient deficiencies—or non-communicable diseases (NCDs).

In recent years, research has supported the role of diets to the health status of an individual, such as the risk for certain diseases. This was made possible by the existence of Food Composition Databases, which analyzed the specific nutrient content of food items. Food database systems are the basis of crafting-recommended dietary reference values [ 17 ]. However, there is a dearth of information regarding the comprehensive assessment of nutrient intakes and food sources of nutrients focused on Filipino working adults. This study aimed to evaluate the dietary intakes and food sources of working adults in randomly selected occupational sectors, and to compare nutrient intakes with the recommended levels. The results of this study could be one of the bases in crafting science-based health and nutrition policies for different job sectors.

2. Methodology

2.1. study design and population.

This was a one-time, cross-sectional survey in randomly selected occupational sectors, such as business process outsourcing (BPO), factory, hospitality and foods, administration, sales, and healthcare. Participants per sector were randomly selected from the list obtained from the respective Human Resource Office. Participants included in this study were aged 19 to 59 years old, able to speak, read, write, and understand English and Tagalog. They had no physical deformities, and had at least one year’s experience in the workplace. Pregnant and lactating women were excluded from the study ( Figure 1 ).

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Study design.

Study sites were the highly urbanized cities (HUC) in the three major islands of the Philippines: Luzon, Visayas, and Mindanao. These were selected from the final results of the 2012 Census of Philippine Business and Industry for All Establishments, classified under the three broad industry groups—namely, Agriculture, Industry, and Services. The total number of establishments across the country in 2012 reached n = 219,184. The Industry sector, with 28,221 establishments, accounted for 12.9% of the total number of establishments in 2012. According to a disaggregation by HUC, the number of business establishments are as follows: the National Capital Region (1,116 establishments), Central Visayas (161 establishments), CALABARZON (41 establishments), Central Luzon (30 establishments), and the Davao Region (24 establishments) [ 18 ]. The sample size computation (see Table 1 ) was computed based on the number of establishments per area, with a 95% level of confidence and 5% margin of error, using the formula below:

where Z α 2 is the critical value of the normal distribution at α/2 (e.g., for a confidence level of 95%, α is 0.05 and the critical value is 1.96), p is the proportion employed per industry, and MOE is the margin of error.

Calculated sample size by job sector.

Work SectorType of WorkMean Age (y)Calculated Sample Size
BPO Call Center Agents31174 (14%)
FactoryAutomotive, Industrial Plants35312 (25%)
Hospitality and FoodsHotel staff, Food Service workers, Waiters, Cooks32140 (11%)
AdministrationOffice Work33272 (21%)
SalesSales Agent and Associates (Real estate, Malls etc.)30260 (21%)
HealthcareNurses, Hospital Staff32106 (8%)
Total sample ( ) 1264

1 Abbreviations: BPO – Business Process Outsourcing.

Socio-economic and demographic characteristics or the general profile, like age, sex, educational level, income, and pre-existing medical conditions of respondents were collected using pre-tested questionnaires through a face-to-face interview.

2.2. Anthropometric Measurements

The height and weight of the respondents were collected using a calibrated stadiometer (207CM SECA 213 Stadiometer) and digital weighing scale (200KG SECA 874 dual display made in Germany), respectively. Height was recorded to the nearest 0.1 cm, while participants were barefoot and standing straight. Weight was recorded to the nearest 0.1 kg. Measurements of both height and weight were taken twice, and the mean was considered for analysis. Body mass index (BMI) was then calculated by dividing the weight in kilograms by the height in square meters (kg/m 2 ). It was interpreted using the World Health Organization (WHO) BMI classification for adults (World Health Organization, 2006), wherein the cut-off points used in classifying the nutritional status of adults 19.0 years old and above were as follows: <18.5:Chronic Energy Deficiency/Underweight; 18.5 to 24.99—Normal; Overweight: 25.0 to 29.99; and Obese: ≥30.0.

2.3. Statistical Analysis for the Usual Energy Intake

Energy and nutrient intakes of the respondents were validated to identify implausible values. In the evaluation and assessment of the energy intake, the ratio of the daily energy intake and Estimated Energy Requirement (EER) of each individual was computed and then transformed to the logarithmic scale to remove outliers below −3SD and above +3SD [ 19 ]. The EER of each respondent was calculated using the Institute of Medicine (IOM) equation, considering age, sex, body weight (kg), height (m), and physical activity level (PAL).

Excessive micronutrient intakes were substituted by a random value generated from uniform distribution in the interval of the lower bound equal to the 95th percentile of the observed intake and an upper bound equal to 1.5 times the 99th percentile. Excessive micronutrient intakes were defined as those that exceeded 1.5 times the 99th percentile of the observed intake of the respondents [ 19 ]. The distribution of calcium, vitamin D, and vitamin E was highly skewed, which caused rejection of normality. Hence, a small amount of random noise ((N~ (0.35, 0.05)) was generated and added to these micronutrient intakes to adjust the intakes and rerun the analysis.

The Recommended Energy and Nutrient Intake of the Philippine Dietary Reference Intake (PDRI) 2015 was used in the evaluation of nutrient inadequacy and excessive intake of the respondents. Prevalence of inadequacy was estimated as the proportion of individuals with usual intakes below the computed average of the male and female estimated average requirement (EAR). All nutrients with EARs were assessed using the EAR cut-point method [ 20 ]. The proportion of individuals with excessive intakes was estimated using a tolerable upper intake level or upper limits per day (UL) as cut-off values.

Acceptable Macronutrient Distribution Ranges (AMDR) were used to evaluate carbohydrates, total fat, and protein intake as a percentage of energy. Nutrients with no EARs used recommended nutrient intakes (RNI) and adequate intake (AI) as a reference value, though they were not applicable to estimate the nutrients’ inadequacy. The mean intakes at or above the AI value could be assumed to have nutritionally adequate diets [ 21 ].

2.4. Dietary Assessment

Dietary intake of the respondents was assessed using a 2-day, non-consecutive, 24 h food recall. The 24 h food recalls of two non-consecutive days were collected using the standard form used by Food and Nutrition Research Institute (FNRI) for National Nutrition Surveys. Standard household measures were used to estimate the quantity of food consumed by the respondents. All household measures were then converted to metric weights by the trained research assistants and validated. After validation, all data were encoded in an e-template designed specifically for the study. Encoded data were again validated against the raw data by the research team. After thorough data-cleaning and validation, dietary intake was processed using a computer system called the Individual Dietary Evaluation System (IDES), developed by FNRI to describe the energy and nutrient equivalent of the food items [ 22 ]. This system makes use of the expanded Filipino Food Composition Table (FCT) containing 27 nutrients from 1359 foods.

Food group consumption was expressed by the percentage of respondents who consumed specific foods or food groups at least once on the first 24 h dietary recall regardless of the amount consumed. This method has been used in the previous studies of Siega-Riz, Deming et al. 2010, Yu, and Denney et al. 2016 [ 23 ]. The weighted percentage contribution of each food group for selected key nutrients was calculated by adding the amount of a given nutrient provided by each food group for all individuals and dividing it by the total intake of that nutrient consumed by all individuals from all foods and beverages.

2.5. Physical Activity

The physical activity of the adults was measured using a modified questionnaire based on activity recommendations on physical activity and health of the WHO Steps Assessment Guide. The respondents were classified as physically active or physically inactive using the questionnaire. A person not meeting any of the following criteria was considered as physically inactive or insufficiently physically active, and therefore at risk of having chronic diseases (World Health Organization STEPS Surveillance, WHO, 2002):

  • Three or more days of vigorous-intensity activity for at least 20 min per day;
  • Five or more days of moderate-intensity activity;
  • Walking for at least 30 min per day.

2.6. Ethical Considerations

This study was ethically conducted in accordance with the declaration of Helsinki, guided by the Council for International Organizations of Medical Sciences’ (CIOMS) Ethical Guidelines for Biomedical Research Involving Human Subjects and the National Guidelines for Biomedical and Behavioral Research, and was approved by the DOST- FNRI Institutional Ethics Review Committee (FIERC) with registry number FIERC 2013-001. All changes (amendments) on the protocol were submitted to FIERC by the Principal Investigator (PI) for approval prior to implementation.

The participants were briefed and oriented about the objectives of the study and the data to be collected. Participation in the study was voluntary, and interested participants were asked to sign the informed consent form (ICF). They were told that they could withdraw their participation from the study at any time without any prejudice or effect on their work performance.

3.1. Socio-Economic, Demographic, and Anthropometric Characteristics of the Study Population

The average age of the respondents was 32 years old with a range of 19–59 years. There was a similar percentage of male and female participants, and most were single (59.6%), Table 2 . The majority of the respondents had either graduated from college or vocational school (63%). The participants were mostly from factory, admin, and sales sectors (66.8%); 14%, 11%, and 8% were from the Business Process Outsourcing (BPO, hospitality, and healthcare sectors, respectively. More than one-third (35%) of all the respondents had a household monthly income of Php25.000 to Php75.000. About 32% had a household monthly income of less than Php25.000 [ 24 ]. The respondents’ main source of funds was from salaries. However, around 19.3% and 3.2% of the respondents had an additional source of income from selling goods and services and money lending, respectively. A majority had been working in their current companies for 1 to 5 years. Based on BMI, almost half of the participants (46.7%) had a BMI >25, which indicates that they are overweight (30.9%) or obese (15.8%), while only 4% were underweight.

Characteristics of the participants ( n = 1264).

Socio-Economic, Demographic Characteristics and Nutritional Status
%
Male63149.9
Female63350.1
Single75459.6
Married46937.1
Separated/Widowed413.24
No education20.2
Elementary graduate755.9
High school graduate39030.8
Vocational/College graduate79763
BPO 17413.8
Factory31224.7
Hospitality14011.1
Admin27221.5
Sales26020.6
Healthcare1068.4
Less than Php25,00040432
Php25,000-Php75,00044335
Php75,001- Php150,00013610.8
More than Php150,000897
Don’t know/Decline to respond19215.3
Salary/Wages1264100
Selling goods/services24419.3
Money Lending/Others403.2
Less than a year39531.2
1 to 5 years51640.8
5 years or more35327.9
Underweight504
Normal61848.9
Overweight39130.9
Obese20515.8
Body Weight (kg)65.115.2
Height (cm)159.88.6
BMI (kg/m )25.44.7

1 Abbreviations: BPO: Business Process Outsourcing; SD: standard deviation.

3.2. Energy Intake

The mean energy intake of working adult men was 1972 kcal/d, and 1566 kcal/d for women. Assuming sedentary physical activity for all participants, the energy intake of males was 18% lower compared to their Estimated Energy Requirement (EER) = 2397 kcal/d), whereas the average energy intake of females was 14% lower compared to their EER (1815 kcal/d). Supposing low active physical activity for all participants, the energy intake was far below than the EERs (24% below for males, and 23% below for females). The amounts of calories that the body needs to function while resting in 24 h (or the BMR) were almost close to the average energy intake for both sexes.

3.3. Nutrient Intake

The usual nutrient intakes of the respondents from the different sectors are presented in Table 3 . With regard to the percentage energy distribution of carbohydrates, protein, and fat, it was seen that the respondents’ intake of these macronutrients were within the acceptable macronutrient distribution ranges (AMDR), except for the protein (15.52%), which slightly exceeded the AMDR of 10% to 15% of the total energy intake.

Mean energy and nutrient intake of working adults by sector.

Mean Intake ± SE
NutrientsAll
( = 1264)
BPO
( = 174)
Factory
( = 312)
Hospitality
( = 140)
Admin
( = 272)
Sales
( = 260)
Healthcare
( = 106)
Energy(kcal/d)1768.8 ± 131761.3 ± 311715.3 ± 25.31990.5 ± 48.81806.9 ± 31.71745.3 ± 281610.6 ± 38.6
EER (kcal)2401.5 ± 122474.4 ± 372440.8 ± 21.32444.7 ± 36.52333.3 ± 26.42382.4 ± 272335.2 ± 45.3
Total fat (g/d)56.56 ± 0.561.6 ± 1.347.2 ± 0.965.1 ± 258.6 ± 1.158.7 ± 1.057 ± 1.4
Saturated fat (g/d)26.73 ± 0.329.8 ± 0.723.3 ± 0.629.6 ± 0.826.9 ± 0.727 ± 0.626.5 ± 0.5
MUFA (g/d)21.20 ± 0.223.9 ± 0.616.9 ± 0.424.7 ± 0.722.1 ± 0.522.2 ± 0.520.1 ± 0.5
9.45 ± 0.110.2 ± 0.37.9 ± 0.210.7 ± 0.410.2 ± 0.29.8 ± 0.28.9 ± 0.3
PUFA (g/d)
Carbohydrate (g/d)238.47 ± 2216.3 ± 4.1251.4 ± 4268.5 ± 7.5245.1 ± 4.7229.5 ± 4.1203.4 ± 5.7
Total sugars (g/d)31.13 ± 0.533.4 ± 1.227.6 ± 0.834.4 ± 1.533.4 ± 129.3 ± 1.232.6 ± 1.4
Dietary fiber (g/d)7.97 ± 0.077.5 ± 0.28 ± 0.18.4 ± 0.28.6 ± 0.27.8 ± 0.27.2 ± 0.3
Protein (g/d)67.14 ± 0.567.9 ± 1.564.6 ± 1.176.6 ± 1.666.1 ± 1.267.2 ± 1.263.7 ± 1.6
Total fat (%)27.75 ± 0.230.1 ± 0.523.6 ± 0.328.2 ± 0.528.6 ± 0.328.9 ± 0.330.5 ± 0.4
Protein (%)15.5 ± 0.0515.6 ± 0.0815.3 ± 0.115.9 ± 0.215 ± 0.0915.6 ± 0.116.5 ± 0.2
Carbohydrate (%)55.27 ± 0.251.9 ± 0.559.8 ± 0.454.7 ± 0.655 ± 0.354.1 ± 0.451.6 ± 0.6
Vitamin C (mg/d)33.24 ± 0.634 ± 1.430.1 ± 0.929.1 ± 1.435.7 ± 1.336 ± 236.9 ± 2.6
Vitamin E (mgα-TE)4.42 ± 0.044.6 ± 0.074.1 ± 0.064.7 ± 0.14.6 ± 0.084.3 ± 0.14.6 ± 0.2
Thiamin (mg/d)0.77 ± 7.40.8 ± 0.010.7 ± 0.010.9 ± 0.020.8 ± 0.020.8 ± 0.020.7 ± 0.02
Riboflavin (mg/d)0.61 ± 5.80.6 ± 0.010.6 ± 0.010.7 ± 0.020.6 ± 0.010.6 ± 0.010.6 ± 0.02
Niacin (mg/d)21.01 ± 0.221.2 ± 0.521.2 ± 0.324 ± 0.520.1 ± 0.420.7 ± 0.419.6 ± 0.5
Vitamin B6 (mg/d)2.42 ± 0.032.4 ± 0.062.3 ± 0.052.5 ± 0.052.4 ± 0.072.7 ± 0.092.1 ± 0.07
Vitamin B12 (µg/d)4.41 ± 0.064.1 ± 0.24.7 ± 0.14.9 ± 0.24 ± 0.14.4 ± 0.15.1 ± 0.3
Folate (µg DFE )179.58 ± 1.7176 ± 5.1187.3 ± 3.3164.6 ± 4.9184.3 ± 2.9180 ± 3.6170.8 ± 6.5
Calcium (mg/d)354.85 ± 3.7339.3 ± 5.6348.8 ± 7.8399.4 ± 14.4371 ± 8.5334.4 ± 9.5373.6 ± 15.3
Phosphorus (mg/d)911.42 ± 7.1883.7 ± 16.8911.7 ± 14.91015.5 ± 19.7909.4 ± 16.5898.6 ± 16.6859.3 ± 21.7
Magnesium (mg/d)183.52 ± 1.5190.0 ± 3.9178.1 ± 2.8198.2 ± 4.6188.1 ± 3.3178.3 ± 3.1169.3 ± 5.5
Vitamin D (µg/d)4.0 ± 0.033.5 ± 0.084.4 ± 0.074.4 ± 0.13.7 ± 0.084 ± 0.094 ± 0.1
Vitamin A (μgRE/d)567.46 ± 7.1557.4 ± 20.3531.2 ± 13.4731 ± 24.6610.4 ± 14.2503.2 ± 11.5528.5 ± 26.3
Iron (mg/d)9.71 ± 0.089.6 ± 0.29.4 ± 0.110.7 ± 0.39.9 ± 0.29.6 ± 0.29.2 ± 0.3
Zinc (mg/d)9.71 ± 0.067.4 ± 0.26.7 ± 0.18.2 ± 0.27.5 ± 0.17.5 ± 0.17 ± 0.2
Sodium (mg/d)1038.6 ± 131160.1 ± 33916.9 ± 21.61086.9 ± 48.41096.1 ± 31.91076.8 ± 29971.6 ± 35.4
Potassium (mg/d)1617.8 ± 121617.7 ± 291532.4 ± 24.51833.1 ± 36.21670.6 ± 28.11598.7 ± 271507.2 ± 37.1
Selenium (µg/d)116.84 ± 1116.7 ± 2.2111.2 ± 1.8139.8 ± 3113.9 ± 2.2117.2 ± 2.1110.8 ± 3.3

SE –standard error.

It was also noticeable that only 7.97 g, or about 30% to 40% of dietary fiber, compared to the recommended nutrient intake (RNI); 20 to 25 g, 33.24 mg, or a little above 50% vitamin C compared to the 65 mg RNI; and 183.52 mg, or about 82% magnesium compared to the 225 mg RNI was consumed by the respondents. Moreover, only 4.42 mg or 44.2% Vitamin E, as compared to the 10 mg adequate intake (AI) and 1617.8 mg, or 81.9% of 2000 mg potassium AI was consumed. On the other hand, the usual diet of the participants had selenium (116.84 µg), which was about 70% higher than the RNI, and sodium (1038.6 mg) that was 51.9% higher than the AI ( Table 3 ).

The prevalence of an inadequate intake of protein was only 24%, while as a percentage of the total energy, it indicated that there was no inadequacy of protein among working adults. Also, there was no inadequacy of total fat as a percentage of total energy. However, it was noticeable that there was an excessive intake of total fat (34%) and protein (58%) as a percentage of the total energy, while a considerably high percentage of inadequacy of carbohydrates (48%) occurred.

In Table 4 , inadequate and excessive intakes are shown. A high prevalence of inadequate intakes was found for iron (99%), folate (98%), riboflavin (96%), calcium (94%), vitamin c (87%), and thiamin (76%), followed by vitamin A retinol equivalent RE (40%). Niacin, vitamin B6, vitamin B12, phosphorus, zinc, and selenium intakes were adequate among working adults. The whole distribution of fiber intake did not meet the range of the recommended fiber intake (RNI: 20–25 g). The mean levels of vitamin D (4 µg/d), vitamin E (4.4 mgα−TE), sodium (1039 mg/d), and potassium (1618 mg/d) were far below their respective AIs (7.5 µg/d, 10 mgα−TE, 500 mg/d, and 2000 mg/d, respectively). The mean magnesium intake was also lower than the recommended magnesium intake (RNI: 225 mg/d).

Prevalence of inadequate and excessive intake of nutrients by sector.

Prevalence of Inadequacy (% < EAR /LAMDR )Prevalence of Excessiveness (% > UL /UAMDR )
All
( = 1264)
BPO
( = 174)
Factory
( = 312)
Hospitality
( = 140)
Admin
( = 272)
Sales
( = 260)
Healthcare
( = 106)
All
( = 1264)
BPO
( = 174)
Factory
( = 312)
Hospitality
( = 140)
Admin
( = 272)
Sales
( = 260)
Healthcare
( = 106)
Protein23.922.829.18.426.523.928.3-------
Total Fat (%)<1<15.91.20<1033.749.613.837.736.339.254.1
Protein (%)00<1000<158.172.751.764.147.561.570.8
Carbohydrate (%)47.767.324.751.149.555.269.8<1<11.2<1000
Vitamin C87.188.892.692.785.281.682.50000000
Vitamin E-------0000000
Thiamin76.683.886.263.872.971.284.9-------
Riboflavin95.898.996.190.893.995.393.6-------
Niacin3.14.63.6<14.42.72.72.33.12.94.72.11.7<1
Vitamin B68.75.911.2<110.611.1100000000
Vitamin B126.211.86.53.311.62.16.3-------
Folate97.996.997.598.699.197.997.10000000
Calcium94.799.894.288.693.29491.60000000
Phosphorus7.56.98.41.38.89.88.40000000
Magnesium--------<1<1<1<1<1<1
Vitamin D-------0000000
Vitamin A39.743.445.616.729.448.148.80000000
Iron9999.499.396.698.599.598.60000000
Zinc2.52.26.2<12.11.71.80000000
Selenium00000000000000

A Estimated Average Requirements; B Lower Acceptable Macronutrients Distribution Range; C Tolerable upper intake level or upper limits per day; D Upper Acceptable Macronutrients Distribution Range.

Other nutrient intakes were compared to the estimated average requirement (EAR) and/or tolerable upper intake level (UL).

3.4. Food Intake

Refined rice, fats and oil, pork, fish, and other vegetables were the top five foods most consumed. The next five food items were chicken, egg and egg dishes, other sweetened beverages, dark-green leafy vegetables, and deep-yellow vegetables. The top five food sources of energy were rice, pork, fats and oils (mostly derived from plant sources), chicken, and bread. Half of the total carbohydrates came solely from refined rice, followed by bread, other sweetened beverages, noodles, and soft drinks. Refined rice, pork, fish, chicken, and egg and egg dishes were the top five contributors of protein. Forty percent (40%) of the total fat intake came from pork, while the other food sources were fats and oil (mostly plant sources), chicken, sausages, and egg ( Figure 2 ).

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Percentage of participants consuming each food group based on a 24 h recall.

Pork, refined rice, bread, noodles, and chicken were the top five food sources of thiamin. For riboflavin, pork, egg, chicken, fish, and powdered milk were the top contributors. Pork, chicken, deep-yellow vegetables, dark-green leafy vegetables, and fish were the top five food sources of vitamin A. Although almost half (42%) of the total vitamin C came from fruits and dark-green leafy vegetables, the prevalence of inadequate levels of vitamin C was still high. Bread, other vegetables, beans, nuts. and peas, dark-green leafy vegetables, and egg were the top five contributors of folate. Although iron and calcium content is not high in rice, it turned out that rice was the top contributor of iron, and the second highest for calcium. The other food sources of iron were pork, bread, sausages, and chicken, whereas for calcium, it was fish, chicken, powdered milk, and pork.

As seen in Figure 3 , with regard to total energy intake, Filipino working adults consumed a significantly higher percentage of rice (36%) and pork (15%) and significantly lower percentages of fats and oils (5%), chicken (4%), as well as bread (4%). In terms of carbohydrates, rice (59%) had the highest percentage contribution, followed by bread (5%), other sweetened beverages (5%), noodles (4%), and soft drinks (3%). Contributions to the total fat intake were made mainly by the pork group (40%), followed by fats and oils (16%), chicken (14%), sausages (6%), and egg and egg dishes (4%). Lastly, with respect to protein intake, the rice group (19%) had the highest percentage contribution, preceded by pork (17%), fish (17%), and egg and egg dishes (5%).

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Percentage contributions of each food groups to the total energy, carbohydrate, protein, and total fat intake.

As seen in Figure 4 , pork, refined rice, bread, noodles, and chicken were the top five food sources of thiamin. For riboflavin, pork, egg, chicken, fish, ye and powdered milk were the top contributors. Pork, chicken, deep-yellow vegetables, dark-green leafy vegetables, and fish were the top five food sources of vitamin A. Although almost half (42%) of the total vitamin C came from fruits and dark-green leafy vegetables. the prevalence of inadequate vitamin C was still high. Bread, other vegetables, beans, nuts, and peas, dark-green leafy vegetables, and egg were the top five contributors of folate.

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Percentage contributions of each food group to the vitamin intake of Filipino working adults.

As seen in Figure 5 , fish, refined rice, cheese, pork, and chicken were the top five food sources of calcium, while iron mainly came from refined rice, pork, sausage, bread, and chicken in the usual diet of Filipino working adults. Although calcium can be found in large amounts in beans and lentils, seeds, fish (e.g., salmon and sardines), and green leafy vegetables, the diets of working adults seemed to lack these food items.

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Percentage contributions of each food group to the calcium and iron intake of Filipino working adults.

3.5. Physical Activity

Almost 6 in 10 respondents were found to be physically inactive (59.10%). The highest percentage of physical inactivity was seen in the admin sector (65.81%). In fact, a majority of the respondents per sector were physically inactive, except from the factory sector which had about 50% of physically inactive respondents ( Figure 6 ).

An external file that holds a picture, illustration, etc.
Object name is nutrients-12-01009-g006.jpg

Percentage distribution of the respondents’ physical activity by sector.

3.6. Medical History

It was revealed that hypertension (25.51%) and acute infection (25.51%) were the most common conditions that were currently being treated among the respondents, while maintenance/prescription drugs (42.06%) and vitamins and mineral supplements (39.56%) were mostly taken. For the past year, reasons for the hospitalization of the respondents were mostly due to infections (33.08%) and chronic diseases (24.06%). Lastly, hypertension (21.50%) and diabetes (20%) were the most common diseases present in their families ( Table 5 ).

Percentage distribution of the respondents with medical conditions, and medications taken.

Disease/Medical Condition Currently Being Treated All ( = 1264)
%
Acute infection6225.51
Allergy93.70
Anemia62.47
Cancer31.23
Cardiovascular disease52.06
Digestive & liver problem218.64
Diabetes166.58
Electrolyte imbalance177.00
Gout, arthritis114.53
Hypertension6225.51
Kidney disease31.23
Muscle/body pain187.41
Neurological disorder52.06
Pulmonary disorder2610.70
Others (HIV, genetic diseases)31.23
Herbal/food supplements7122.12
Hormonal/birth control pills154.67
Maintenance/prescription drugs13542.06
Slimming pills20.62
Vitamin & mineral supplements12739.56

m Multiple answers.

4. Discussion

This study evaluated the usual nutrient intakes and food sources of working adults in the Philippines, where the employment rate of those who are 15 years old and over is about 94.3%. About 56.3% are in the Services sector, and 25.4% and 18.3% are in the Agriculture and Industry sectors, respectively [ 16 ]. Developing nations like the Philippines need to break the cycle of poor nutrition, low productivity, and low wages. Generally, lack of access to healthy foods has been cited as one of the main barriers to a healthy diet in the workplace.

4.1. Inadequate Energy and Nutrient Intake

The results of the study indicated key nutrients among the working adults. It has been postulated that a poor diet for working adults, resulting in either under-nutrition or overweight and obesity, is causing up to a 20% loss in productivity [ 14 ]. Data on the usual energy and nutrient intakes of the respondents from a 2-day, non-consecutive, 24 h food recall showed that the mean usual energy intake of the respondents did not meet the estimated energy requirement (EER), but looking closely at the percentage contribution of the different macronutrients to total energy intake, the protein and total fat intake as a percentage of total energy intake was 58% and 34% excessive, respectively. Protein mainly came from rice (19%), pork (17%), and fish (17%), while the fat intake was derived from pork (40%). From this, it can be deduced that the prime source of energy came from proteins and fats. Studies have strongly associated excessive fat and protein consumption with increasing BMI among adults [ 25 ], which was seen in this present study, wherein a BMI >25 was 47%. Other studies associated an increase of about 23% to risk in early death among males where their primary source of protein came from animals, compared to their plant-based protein-equivalent group [ 26 ]. However, it must still be noted that in general, protein consumption among working adults does not meet the RNI. The top three food groups consumed every day by all the respondents during the reference period of the past 7 days were refined rice (97%), oils and fats (74%), and pork (53%). Top food sources for the energy of working adults were rice (35.6%), pork (15.1%), fats and oils (4.7%), chicken (4.4%), and bread (3.8%). This may explain the excessive protein and fat intake and inadequate fiber intake of only 30% to 40% of the WHO Recommended Nutrient Intake (RNI) since the top foods consumed are rich in protein and fats but lack dietary fiber. The fat intake of the respondents had more saturated fats (pork = 40%), which are known for their loe density lipoprotein (LDL) cholesterol-raising potential and effects on risks of cardiovascular disease (CVD) [ 27 , 28 ]. Excess dietary saturated fat intake can be stored in the body, and when not expended, can accentuate risks of obesity [ 29 ]. It is also noted that carbohydrate intake as a percentage of total energy among all sectors was inadequate, but still represented about 47.7% of the total energy intake. Top sources for carbohydrates of the working adult population came from rice (35.6%), bread (5.3%), sweetened beverages (4.8%), and noodles (4.3%), which are considered “low-quality carbohydrates” because of their poor nutrient content and association with risks of disease [ 30 ]. Similar consumption patterns in the USA involving sugar-sweetened beverages were most likely associated with higher energy consumption, contributing to the obesity epidemic [ 31 ]. Legislation on heavily taxed sugar sweetened beverages was implemented in the Philippines early in 2018, and health incomes of this tax have yet to be evaluated [ 32 ].

The poor quality of food intake of respondents is reflected in the high prevalence of nutrient inadequacies: iron (99%), folate (98%), riboflavin (96%), calcium (94%), vitamin C (87%), thiamin (76%), and vitamin A (40%). This strongly suggests that consumption of energy-dense foods by the working adult population displaces the consumption of nutrient-dense foods [ 33 ]. This might be one factor that may have contributed to the high prevalence of hypertension (25.5%) and diabetes 6.6% among the respondents. In a similar study in the United States, subjects that tend to consume energy-dense, but nutrient-poor foods were found to consume an increased amount of sugars, fats, sodium, and alcohol and had a decreased diet quality, which increased the risk for these individuals to acquire chronic diseases, such as coronary heart disease (CHD) [ 34 ]. Other studies suggest that increased urbanization, coupled with globalization of the food market can be attributed to the dietary shift towards refined sugars, fats and oils, and processed meats, and a decline in fruit and vegetable consumption [ 35 ]. Multiple-micronutrient deficiency has been called the “hidden hunger”, as these nutrients can aggravate factors for an individual’s health outcome and quality of life [ 36 ]. Several studies have linked early-onset micronutrient deficiencies to an increased risk of chronic, non-communicable diseases later on in life, and thus, prevailing inadequate intakes of key micronutrients of working adults exposes this population to the development of NCDs. Poor nutrition among workers is already viewed as an occupational health hazard [ 37 , 38 ]. Micronutrient deficiency has a direct impact on worker productivity and performance, as pointed out in the study of Lukaski in 2004 [ 39 , 40 ]. In this study, infections, anemia, and CVD were mentioned as the pre-disposing health conditions of the respondents, and most were under maintenance medications ( Table 5 ). Extremely high micronutrient inadequacies in iron (99% inadequacy), calcium (94% inadequacy), folate (98% inadequacy), and riboflavin (96% inadequacy) may predispose this population to higher risks of infections and NCDs.

In previous studies, workplace factors that were linked to improved eating habits of workers included food-related policies, health and nutrition promotion, creating a supportive nutrition-promoting environment, and offering healthy foods in the workplace canteen. Cross-level interactions between the workplace nutrition environment and canteen management attitude towards the health and diet of workers were significantly associated with eating practices [ 40 ]. Therefore, worksites are potential environments to promote healthy eating by making healthy food choices available in the canteens and neighborhood food establishments.

4.2. Physical Activity and Inactivity

This study indicated a high prevalence of physical inactivity among Filipino workers, with 59.1% of adults being classified as inactive since they did not meet the standard guidelines of the WHO global approach to physical activity and health [ 41 ]. Marked inactivity was predominant among the Admin sector, with 65.81% of adults not meeting the recommendation for physical activity, while factory workers had a half-on-half situation, citing 50% of its workers as active and the other half as inactive. Our data confirms the rising level of physical inactivity among adults aged 20 years and over cited in the 2013 National Nutrition Survey [ 11 ]. The literature has pointed out the detrimental effects of prolonged physical inactivity on people’s health [ 42 , 43 ]. Evidential research has stated that prolonged inactivity increases the risk for coronary vascular accidents, type II diabetes, cancer, obesity, musculoskeletal problems, and psychological disorders, including depression and anxiety [ 44 ]. The nature of administrative work done in a seated manner forcibly engages the worker to become inactive, where office work and driving tasks are especially characterized by long periods of uninterrupted sitting. As the number of administrative and desk jobs increase, the risk of an increasing prevalence of NCDs is imminent [ 45 ]. Research still continues to support the public health need of a culture suitable for regular physical activity.

This study highlighted that Filipino workers are vulnerable to disproportional macronutrient and micronutrient intake. Energy, carbohydrates, proteins, and key micronutrient intake were markedly inadequate. However, the percentage contribution of proteins and fats of the total energy consumption of working adults were found to be excessive. The high prevalence of overweight and obesity coupled with micronutrient deficiencies predispose these individuals to CVD and other NCDs. This is aggravated by a dietary pattern shift to an increasing intake of non-nutrient-dense foods, like refined sugars, fats and oils, and processed meat products, while having a diminishing intake of fruits and vegetables, coupled with the sedentary nature of their jobs.

These findings could be used by policy-makers in the Philippines as one of the bases for developing programs, interventional policies, and initiatives addressing the needs of these sectors, like the provision of healthy and safe food canteens in the workplace and its food environment.

4.3. Limitations of the Study

The study had a cross-sectional design; hence, there was no cause–effect relationship. Although the findings on intake is revealing and previous literature reviews support the negative consequences of high-fat, high-protein intake, we still consider the possibility of recall bias on food intake and physical activity data. Measurement of obesity was done only using BMI, and other indices, like the waist-to-hip ratio, or hip and waist circumference were not measured.

Acknowledgments

The authors would like to acknowledge Ariane A. Aquino, Rose Aviegael D. Dichosa, Mark Alvin L. Angeles and John Marvin M. Reyes for their technical contributions to this study.

Abbreviations

WHOWorld Health Organization
EAREstimated Adequate Requirement
AMDRAcceptable Macronutrient Distribution Ranges
EEREstimated Energy Requirements
GDPGross Domestic Product
LMICLow-Middle Income Countries
NCDNon-Communicable Diseases
COPDChronic Obstructive Pulmonary Disease
FCTFood Composition Table
BPOBusiness Process Outsourcing
BMIBody Mass Index
IOMInstitute of Medicine
PALPhysical Activity Level
AIAdequate Intake
RNIRecommended Nutrient Intakes
FNRIFood and Nutrition Research Institute
CIOMSCouncil for International Organizations of Medical Sciences
FIERCFNRI Institutional Ethics Review Committee
ICFInformed Consent Form
BMRBasal Metabolic Rate
LDLLow Density Lipoprotein
CVDCardiovascular Disease
CHDCoronary Heart Disease

Author Contributions

I.A.-A. designed the study and analysis, drafted the manuscript, and had the final responsibility for the contents. M.R.S.C. assisted in the analysis, interpreted the data, edited the manuscript, and held responsibility also for the contents. All authors have read and agreed to the published version of the manuscript.

This research was funded b Nestle Philippines, Inc.

Conflicts of Interest

The authors declare no conflict of interest. The design, data collection, analysis and write-up of research study are solely done by the Authors. The funds were provided by Nestle Philippines, Inc.

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Title: How other countries influenced Filipino food

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Palapat Tart: A Healthy Dessert

22 Pages Posted: 2 Mar 2021

Bulacan State University; Lyceum of the Philippines Manila

Maria Cecilia De Luna

Bulacan State University

Rochelle Valdizno

BULACAN STATE UNIVERSITY

Joshua Roman

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Filipinos are known for having sweet tooth. According to scientists, the human liking for sweets was a variation of a stage when food was rare. In article by Lasco (2017) which was posted at the Inquirer.Net, the Philippines was very much part of sugar’s history, being in the region where sugarcane originated, and where sugar haciendas figured greatly in its colonial economy. This heritage of sugar production hints at why Filipinos use sugar in everything: As historian John Larkin wrote, sugar manufacturers expanded the domestic market “by exciting the Filipino taste for their product” through ad campaigns and free packets of sugar. Sugar’s place as a status symbol, its sheer addictive quality, relatively cheap prices, and our being accustomed to high levels of it in our foods can thus explain why Filipinos have a sweet tooth. The Sonneratia alba, Apple Mangrove in English or known as “Palapat” to many Filipinos, is the subtlest plant of the mangrove species, which are abundant in the coastal ecosystem of Hagonoy, Bulacan,Philippines. It is often used as souring agent in many of Filipino dishes most especially Sinigang. To be able to create livelihood for the people of Bulacan, and to be able to maximize the utilization of the “Palapat” fruit, the researchers came up with the idea of creating an innovative product “Palapat Tart” which will be liked by many. This study covers the essential aspects of developing “Palapat Tart” in terms of product description, ingredients, procedure and tools and equipment needed in its preparation. Also, this will investigate the acceptability of the sensory quality of “Palapat Tart” in terms of taste, aroma, texture, and overall acceptability. The study was conducted on selected residents of Hagonoy,Bulacan and the faculty and staff of Bulacan State University – Hagonoy Campus.

Keywords: product development, dessert, tart, healthy

Suggested Citation: Suggested Citation

Lena Canet (Contact Author)

Bulacan state university ( email ).

Capitol Compound Brgy Guinhawa Mc Arthur Hway Malolos City, 3000 Philippines

Lyceum of the Philippines Manila ( email )

MANILA, PHILIPPINES Philippines

BULACAN STATE UNIVERSITY ( email )

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  • January 2022

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