Pakistan Nutrition and Dietetic Society | 2016 NEWSLETTER
page-template-default,page,page-id-4104,ajax_leftright,page_not_loaded,,footer_responsive_adv,hide_top_bar_on_mobile_header,qode-theme-ver-16.6,qode-theme-pnds,wpb-js-composer js-comp-ver-5.4.5,vc_responsive



Newsletter of Pakistan Nutrition & Dietetic Society

Dear Readers,
Greetings and Eid Mubarak from PNDS !

I am pleased to inform you that in this issue, the review article is written by Dr Vimal S. Karani. He is an Assistant Professor in Nutrigenetics at the University of Reading,UK.
I met Dr Karani at a Nutrition workshop in Islamabad organized by Higher Education Commission (HEC) and British Council Pakistan. I was inspired by his expertise in the field of Nutrigenetics. As limited work is done in Pakistan in the aforementioned field, thus it is important to develop awareness among nutritionists and dietitians. More so as this is an era of “Personalised Nutrition”. Hence I requested him for an article with particular focus on “Nutrigenetics and South Asia” which he accepted whole heartedly. We hope that in near future we will be able to invite Dr Karani as a guest speaker in one of our events, meanwhile read his informative and enlightening article.
Your contributions, suggestions and comments are welcome.

Sumaira Nasim
Chair PNDS Newsletter committee.

Newsletter Committee

Chair: Sumaira Nasim
Committee member: Nida Jawed 

Editorial Board:
Dr Salma Badruddin
Sarah Allahwala

Guidelines for Contributors:

Type of article         Word limit
Review article          1000-1500
Original Research      950-1000
Research Abstract     250
& brief Reviews


Lt.Cdr Rabia Anwer General Secretary PNDS
Greetings from PNDS !

The year started with the first CNE conducted on 2nd January 2016 on “Nutrition Significance: Post surgery and wounds”. Speaker was Sidra Raza, Dietitian at The Agha Khan University Hospital. More than 60 participants attended the session.
Lahore Chapter also conducted a CNE on “Meal Planning Strategies in Diabetes” on 23rd February 2016. Speaker was Dr Asif M Kadri, Consultant Diabetologist.  A total of 30 people attended the CNE.
PNDS Karachi chapter held its 2nd CNE on “Food Safety and Quality Management” on 5th March 2016.  Speakers were Dr. S.M. Naushad Zafar  and Mudassir Nazir, Food Production Manager at SGS Labs. More than 70 participants attended the session.
March Nutrition Month is a nutrition education and awareness campaign celebrated every year.  This year theme is “Savor the Flavor of eating right “and target population was elderly population of Pakistan. For this purpose a supplement was published in Urdu. 30,000 copies were distributed all over the Pakistan.
Similarly, a seminar was arranged on 8th March 2016 by Mrs Mussarat Bhatti, Consultant Dietician at Combined Military Hospital (CMH) Rawalpindi. On this occasion Dr Rezzan Khan’s presented a paper on ‘Obesity and Sleep Deprivation.  Saeed Qadir from UNICEF and Hajra Ahmed from Allama Iqbal Open University presented a papers on “Pakistan Nutrition Road Map” and “Power of Nutrition” respectively .
Other activities conducted by Islamabad Chapter include  Dr Rezzan talk on “Weight Loss Management”, “Role of dietitian / nutritionist among other health care professionals”  by Consultant Dietitian Ayiza Umar and Nutrition Awareness sessions for members of Gun and Country Health Club Islamabad.
Moreover, in month of March , PNDS Islamabad Chapter arranged school activities at  “Army Public School Rawalpindi” by Mussarat Bhatti, Dietitian at CMH Rawalpindi and Nutrition awareness at  The City School by Brirah Altaf, Dietitian at Shifa International Hospital.
PNDS Islamabad Chapter organized its first CNE session on 30th March 2016, on “Nutrition in the ICU- Latest guidelines” by Rezzan Khan. About 30 participants from different hospitals and educational institutes of Rawalpindi, Islamabad and Peshawar attended the CNE.
Lt.Cdr Rabia Anwer, General Secretary PNDS was awarded Tamgh-e-Imtiaz (Military) on 23rd March 2016 as recognition of her services for Pakistan Navy as dietitian.
Nida Jawed Vice President PNDS was invited as guest speaker to give a presentation on “Nutritional Assessment Tools” for the students of Food Science and Nutrition Department, Jinnah University for Women Karachi on 30th March 2016.
Lahore chapter arranged one Day Training Workshop on “Food Addiction, Emotional Eating and its Management”. Speakers were Dr Sohail Sheikh Senior Psychiatrist,  Maria Nadeem Khan RD,  and Amina Iftikhar clinical psychologist.
Dr Salma Badruddin  and Dr Nilofer Safdar represented PNDS as  speakers in the 2nd International Malnutrition Conference-MALNUTRITION KILLS organized by Food, Science and Nutrition Department of Baha Uddin Zakria University, Multan on 6-7th  April 2016.
So this is all till April 2016, visit our website for updates or email your feedback and suggestions at

Nutrigenetics for personalized nutrition: How far are we?

Dr Vimal Karani S, Assistant Professor at Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading UK

Over the past decade, rapid development in the field of genetic epidemiology has allowed the discovery and better description of genetic variations and their contributions to various chronic diseases such as obesity, cancer, cardiovascular disease (CVD) and diabetes. Research in the field of nutrition has shifted its attention from physiology to genetic epidemiology, which includes nutrigenetics and nutrigenomics that refer to the effect of genetic variation on dietary response and the role of nutrients and bioactive food compounds in gene expression, respectively 1-3 . Use of this genomic information along with the findings from various omics technologies enables us to better understand interactions between genes and nutrients and also to develop personalized nutrition strategies and functional foods for disease management and prevention 3. The three central factors that underpin nutrigenetics and nutrigenomics are i). great diversity in the inherited genome between ethnic groups which can affect nutrient bioavailability and metabolism, ii).  Individuals differ greatly in their food availability and food choices depending on cultural, economical, geographical and taste perception differences and iii). Malnutrition (nutrient deficiencies) can affect expression of several genes and stability of the genome.
Although individuals may share the same genome, it is estimated that there are more than 10 million single nucleotide polymorphisms (SNPs) that are present in at least 1% of the population. However, only a small proportion of SNPs have a functional effect. Therefore, the aim of nutrigenetics research is to determine how combinations of different SNPs may affect individual variations in response to diet, including metabolic responses to particular nutrients, specific nutritional requirements and susceptibility to disease outcomes 4 . By understanding the genetic basis for individual variations in response to diet, a more accurate measure of the effects on health and disease risk can be determined. This then not only allow personalised dietary interventions for genetically predisposed individuals, but can also improve public health recommendations based on genetic evidence linking specific dietary components to health outcomes.

Evidence of gene-diet interactions 

One example where a gene-nutrient interaction has strong evidence is the fat mass and obesity-associated (FTO) gene variant rs9939609 SNP. The presence of this FTO gene variant is associated with increased risk of obesity among Caucasians5 and Type 2 diabetes among South Asians 6. One study has shown that when given unlimited supply of food, children with the variant associated with obesity consumed more calories in the form of energy-dense food than those who do not carry this variant7. This suggests that the presence of the FTO variant may contribute to susceptibility to obesity through greater food intake and impaired satiety. A number of studies have replicated and confirmed the association with obesity risk in various populations 8,9 and the FTO is now recognised as one of the most important gene predisposing to obesity10.
The transcription factor Peroxisome Proliferator Activated Receptor – gamma (PPAR-γ) is predominantly expressed in adipose tissue to regulate fat metabolism11. It is also present in other tissues such as muscle and endothelium, where it plays a role in insulin sensitivity and blood pressure. This has led to PPARG being a prime candidate gene for Type 2 diabetes and CVD nutrigenetic research. Common polymorphism, Pro12Ala, in the PPARG gene has been associated with an increased risk of adiposity and insulin resistance, but a decreased risk of metabolic syndrome and Type 2 diabetes 10,12,13. The Ala allele of this polymorphism was associated with lower BMI and improved insulin sensitivity 14 but inconsistent results in other studies has prompted a meta-analysis that conclude a significant higher diabetes risk (1.25-fold) for Pro 12 Pro genotype as compared to the 12 Ala carriers 15. Interestingly, obese phenotypes seem to exacerbate this detrimental effect on insulin sensitivity. Therefore, Pro12 Ala polymorphism provides an excellent example of gene-nutrient interactions in the development of obesity and Type 2 diabetes.

Current challenges in nutrigenetics
Nutrigenetics is still quite a new research area and standardized protocols are not well- established 16. Most often, results are difficult to replicate among populations due to population stratification (or otherwise called ‘population structure’), making conclusions difficult to draw. Perhaps, prospective genotyping (to test novel candidate gene variants identified by genome-wide approaches) that represents majority of the data in consortia-based studies can increase the power to determine associations. Publication bias results in positive associations being reported more often than negative associations which could lead to the increase in false-positive rate especially in large-scale meta-analysis of the published data on gene-nutrient interactions. While most studies only consider one SNP per gene, personalized nutrition requires the knowledge of multiple gene-nutrient-environment interactions from haplotype databases and bio banks to allow more complete understanding of nutrigenetics 3,17 . Investment in these databases is necessary for nutrigenetics to progress and serve its purpose in public health nutrition.
For genetic testing and personalized nutrition to be applied, several ethical issues must be considered 18. Firstly, it is unclear as to whether individuals are willing to participate in genetic testing 19,20 . A survey conducted in USA has reported that 62% of respondents have never heard of nutrigenetics but if specific products arise from nutrigenetics research, they expressed interest in functional foods. More awareness is required to educate the public about the concept of such technology and the value of personalized nutrition in a public health context 21.
Collection and storage of genetic information in databases gives rise to questions regarding who has control and access to use that information. Clearly, there will be commercial interest such as genetic testing and insurance companies, who might also be interested in getting access to the genetic information. Therefore, handling of genetic data must be carefully regulated if nutrigenetics is to be materialised.
If nutrigenetics is to advance the role of nutrition in public health, the question is that whether genetic testing, nutrition consultations and functional food products will be affordable to all members of the public. This raises concerns that only the well-educated and financially-privileged will be able to access nutrigenetics. The knowledge of being -higher at risk for a particular disease may motivate individuals to accept dietary interventions but nutrigenetics can also risk raising anxiety through misinterpretation of individual’s risk. On the other hand, individual without the genetic susceptibility may think that they can eat anything they like.

Nutrigenetics in Asia: 
The inter-individual variability in the response to a diet is particularly evident in South Asian countries that have diverse ethnic backgrounds 22, and have undergone a rapid socio-economic transition. Increase in life expectancy has given rise to an epidemiologic transition such that mortality from malnutrition and infectious diseases has largely been replaced by chronic non-communicable diseases such as obesity, diabetes, CVDs and cancer. It has become apparent that the epidemiologic transition has not affected all ethnic groups equally, particularly in relation to metabolic and CVDs. As has been observed in several other populations, Asian Indians and Pakistanis appear to be at high risk of Type 2 diabetes 23,24 and CVDs 19,20. The rate of myocardial infarction in South Asians is threefold than that of Chinese. Obesity is most common amongst the Malays with the pattern of fat distribution being more peripheral. In contrast, Asian Indians have a larger waist circumference and an elevated insulin resistance 23,27. Asian Indians also have a higher prevalence of diabetes and the lowest levels of high-density lipoprotein cholesterol compared to the Chinese. Given that environmental factors such as unhealthy diet and physical inactivity play an important role in the pathogenesis of the chronic diseases such as obesity and diabetes, it seems unlikely that genetic differences per se underlie these ethnic differences 28. If indeed genetic variants are involved, it is more likely that genetic variants contribute to susceptibility to disease through modulating the effects of a modern urban environment on an individual’s physiology.


Nutrigenetics is a fairly new area of public health nutrition that aims to determine interactions between individual genetic variation (SNPs) and response to diet and the association with a disease or trait. The ‘one size fits all’ approach in disease management has not been fully effective, as public health recommendations fail to result in appreciable benefit to individuals. However, with advancement of nutrigenetics research, a progression from treatment to early risk detection and prevention based on individual’s genetic predisposition seems achievable. Use of evidence-based approach is very important in nutrigenetics and in order to provide more scientific evidence between diet-gene interactions, there is a need for more studies and more variety in examined populations. The investment in intervention studies which will include more people from diverse range of ethnic groups and extensive genotyping along with deeper, standardized phenotyping will give more promising results for the prevention and treatment of polygenic diseases. Consideration of multiple gene-nutrient-environment interactions is important to provide accurate personalized nutrition recommendations in the future. Therefore, investment in haplotype databases and biobanks is vital for collecting all the findings together to have a complete understanding for nutrigenetics. To date, a number of SNPs have shown evidence for gene-diet interactions and diet-related disease risk 8, 29 – 31. Nutrigenetics has highlighted the complexity of those interactions but it offers opportunities to re-evaluate criteria used to set dietary guidelines and the contribution of genetic variation to optimal nutrition for individuals. If the interactions between genetic variation and nutritional requirements are better understood, dietary recommendations could be personalized according to genotype to ultimately promote health and reduce disease risk.

1.    Fenech M, El-Sohemy A, Cahill L, et al. Nutrigenetics and nutrigenomics: viewpoints on the current status and applications in nutrition research and practice. Journal of nutrigenetics and nutrigenomics 2011;4:69-89.
2.    Mutch DM, Wahli W, Williamson G. Nutrigenomics and nutrigenetics: the emerging faces of nutrition. FASEB journal : official publication of the Federation of American Societies for Experimental Biology 2005;19:1602-16.
3.    Vimaleswaran KS, Roy CL, Claus SP. Foodomics for personalized nutrition: How far are we? Current Opinion in Food Science 2015;4:129-35.
4.    Berna G, Oliveras-Lopez MJ, Jurado-Ruiz E, et al. Nutrigenetics and nutrigenomics insights into diabetes etiopathogenesis. Nutrients 2014;6:5338-69.
5.    Frayling TM, Timpson NJ, Weedon MN, et al. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science 2007;316:889-94.
6.    Yajnik CS, Janipalli CS, Bhaskar S, et al. FTO gene variants are strongly associated with type 2 diabetes in South Asian Indians. Diabetologia 2009;52:247-52.
7.    Cecil JE, Tavendale R, Watt P, Hetherington MM, Palmer CN. An obesity-associated FTO gene variant and increased energy intake in children. The New England journal of medicine 2008;359:2558-66.
8.    Vimaleswaran KS, Angquist L, Hansen RD, et al. Association between FTO variant and change in body weight and its interaction with dietary factors: the DiOGenes study. Obesity 2012;20:1669-74.
9.    Willer CJ, Speliotes EK, Loos RJ, et al. Six new loci associated with body mass index highlight a neuronal influence on body weight regulation. Nature genetics 2009;41:25-34.
10.    Phillips CM. Nutrigenetics and metabolic disease: current status and implications for personalised nutrition. Nutrients 2013;5:32-57.
11.    Lovegrove JA, Gitau R. Personalized nutrition for the prevention of cardiovascular disease: a future perspective. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association 2008;21:306-16.
12.    Radha V, Vimaleswaran KS, Babu HN, et al. Role of genetic polymorphism peroxisome proliferator-activated receptor-gamma2 Pro12Ala on ethnic susceptibility to diabetes in South-Asian and Caucasian subjects: Evidence for heterogeneity. Diabetes care 2006;29:1046-51.
13.    Vimaleswaran KS, Radha V, Jayapriya MG, et al. Evidence for an association with type 2 diabetes mellitus at the PPARG locus in a South Indian population. Metabolism: clinical and experimental 2010;59:457-62.
14.    Deeb SS, Fajas L, Nemoto M, et al. A Pro12Ala substitution in PPARgamma2 associated with decreased receptor activity, lower body mass index and improved insulin sensitivity. Nature genetics 1998;20:284-7.
15.    Altshuler D, Hirschhorn JN, Klannemark M, et al. The common PPARgamma Pro12Ala polymorphism is associated with decreased risk of type 2 diabetes. Nature genetics 2000;26:76-80.
16.    Frazier-Wood AC. Dietary Patterns, Genes, and Health: Challenges and Obstacles to be Overcome. Current nutrition reports 2015;4:82-7.
17.    Lovegrove JA, Gitau R. Nutrigenetics and CVD: what does the future hold? Proc Nutr Soc 2008;67:206-13.
18.    Fallaize R, Macready AL, Butler LT, Ellis JA, Lovegrove JA. An insight into the public acceptance of nutrigenomic-based personalised nutrition. Nutrition research reviews 2013;26:39-48.
19.    Ronteltap A, van Trijp H. Consumer acceptance of personalised nutrition. Genes & nutrition 2007;2:85-7.
20.    Ronteltap A, van Trijp JC, Renes RJ. Consumer acceptance of nutrigenomics-based personalised nutrition. The British journal of nutrition 2009;101:132-44.
21.    Ghosh D. Future perspectives of nutrigenomics foods: benefits vs. risks. Indian journal of biochemistry & biophysics 2009;46:31-6.
22.    Tai ES, Tan CE. Genes, diet and serum lipid concentrations: lessons from ethnically diverse populations and their relevance to coronary heart disease in Asia. Current opinion in lipidology 2004;15:5-12.
23.    Anjana RM, Pradeepa R, Deepa M, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54:3022-7.
24.    Basit A, Riaz M, Fawwad A. Improving diabetes care in developing countries: the example of Pakistan. Diabetes research and clinical practice 2015;107:224-32.
25.    Enas EA, Kuruvila A, Khanna P, Pitchumoni CS, Mohan V. Benefits & risks of statin therapy for primary prevention of cardiovascular disease in Asian Indians – a population with the highest risk of premature coronary artery disease & diabetes. The Indian journal of medical research 2013;138:461-91.
26.    Raza S, Sheikh MA, Hussain MF, et al. Dietary modification, body mass index (BMI), blood pressure (BP) and cardiovascular risk in medical students of a government medical college of Karachi. JPMA The Journal of the Pakistan Medical Association 2010;60:970-4.
27.    Vimaleswaran KS, Radha V, Anjana M, et al. Effect of polymorphisms in the PPARGC1A gene on body fat in Asian Indians. International journal of obesity 2006;30:884-91.
28.    Vimaleswaran KS, Loos RJ. Progress in the genetics of common obesity and type 2 diabetes. Expert reviews in molecular medicine 2010;12:e7.
29.    Vimaleswaran KS, Power C, Hypponen E. Interaction between vitamin D receptor gene polymorphisms and 25-hydroxyvitamin D concentrations on metabolic and cardiovascular disease outcomes. Diabetes & metabolism 2014;40:386-9.
30.    Vimaleswaran KS, Cavadino A, Hypponen E. APOA5 genotype influences the association between 25-hydroxyvitamin D and high density lipoprotein cholesterol. Atherosclerosis 2013;228:188-92.
31.    Roswall N, Angquist L, Ahluwalia TS, et al. Association between Mediterranean and Nordic diet scores and changes in weight and waist circumference: influence of FTO and TCF7L2 loci. The American journal of clinical nutrition 2014;100:1188-97.

Dr. Rezzan Khan: A Nutritionist’s 30 Years Journey

In the summer of 1985 Dr. Rezzan Khan moved to Islamabad accompanying her husband and three school-going sons. She had high hopes that with a Doctorate degree from USA, experience working as the head of the nutrition department in one of Turkey’s top universities, and quality research work to her credit, she would be able to find work as a nutritionist.
However, in the 1980’s it was not customary to have nutritionists working in hospitals in Pakistan or was there any credible nutrition department in any Pakistani University. With time on her hands, Dr. Rezzan volunteered in rural development NGO to help destitute people receive nutritional guidance; this helped a number of malnourished poverty-stricken women and children.
She continued in this capacity for 10 years and helped many grass root NGO’s, but professionally it was not satisfying to her. Meanwhile, around 1995, a dozen enterprising doctors from USA and UK had started a new institution, Shifa International Hospital in Islamabad, with the vision of creating a world-class medical institute. She contacted the new hospital but to her utter disappointment she was informed that there was no post of nutritionist in the hospital.
However, Dr. Rezzan was determined to convince the administration of Shifa Hospital to create a post of nutritionist, as in all leading hospitals in Europe and USA had an nutritionist as an integral member of the staff. The senior doctors who had started Shifa hospital had first-hand experience in top hospitals in USA and UK, and understood the importance of professional nutritional expertise in the hospital setting. Thus, it did not take much effort for Dr. Rezzan to convince them of the need for a staff nutritionist. Within a month after first contact Dr. Rezzan was offered a post of nutritionist in the newly established Shifa International Hospital.
The late Dr. Zaheer, the CEO was so happy with her work that she was given full power to set up the Nutrition Clinic on modern lines. Furthermore, the executive committee recognized her contribution and expertise by making Dr. Rezzan a consultant and gave her a free hand to make the Shifa Nutrition Clinic a success.
As nutritional therapy was not well-known in Pakistan, she used to get 3 to 5 patients in a month but she persisted in her efforts to grow the Clinic. She started arranging free nutritional camps, and invited people for nutritional seminars through newspapers articles. She tried her best to create awareness of the importance of diet and nutrition.
In Shifa hospital Dr. Rezzan started checking the physician’s orders on diet, and started correcting them on her own. This annoyed some of the physicians, especially if they were not used to having a nutritionist in the hospitals. Indeed, there was an incident when a physician instructed the nursing staff to add 16 raw egg whites to the diet of a patient, but she changed his order. He put a note on the patient’s file asking “who asked you to see my patient?”
She replied in a nice way and explained the importance of avoiding  too many raw-egg interactions for patients and provided him with the latest references. She remained proactive, and kept on suggesting improvements to diet orders without any referral, and each time she provided scientific reference as well. Many physicians appreciated her help, and the patients benefited from her expertise, however there was still some confusion due to the lack of experience of some physicians with nutritional intervention.
Finally, the medical director at Shifa hospital circulated a memo that Dr. Rezzan may see any patient, and can change orders of the physicians if necessary. Soon she got noticed by other institutions and organizations, and was frequently asked to deliver lectures on nutrition. She accepted all the invitations and kept on helping people and creating awareness.
She took part in scientific conferences, workshops and seminars, to promote nutrition and benefit the audience with her expertise. As awareness spread about the importance of nutritional planning to good health, the out-patient numbers at the Shifa Nutrition Clinic increased. Today, satisfied patients regularly refer other patients to the Shifa Nutrition Clinic, and Dr. Rezzan and her team are well known in the Pakistani nutritional and medical community.
Dr. Rezzan advises her protégés to enjoy what they are doing, practice humility by never thinking that they are the best, and to always be unsatisfied with their mastery of their subjects. There is always room to develop further professionally, and it is important to remember that numerous people are waiting for your help.






Pakistan Nutrition and Dietetic Society


Newsletter of Pakistan Nutrition & Dietetic Society
Volume 10, No.1 March – June 2016

Dear Readers,

Hope all of you are well. On the behalf of PNDS, we wish that each day of New Year be filled with success for all of us. For PNDS, 2015 was full of activities and achievements. This included workshops in collaboration with the British Council, Nutrition Cell, Sindh and Dow University of Health Sciences (DUHS). CNEs which are regular PNDS events were conducted throughout the year for the professional development of nutritionist and dietitians.

Many PNDS members attended national and international conferences to improve skills and competencies in field of nutrition and dietetics. Active participation in professional development events shows enthusiasm and reflects that the nutrition profession is flourishing in Pakistan.

I encourage all of you to come forward and participate in professional development activities, such as, writing articles for our Newsletter, avail opportunities as speakers at CNEs, public awareness sessions and scientific meetings. PNDS is also planning to celebrate March Nutrition Month, 2016. So come forward with ideas and participate.

Kind Regards,

Sumaira Nasim
Chair, PNDS NL Committee

Newsletter Committee

Chair: Sumaira Nasim
Committee member: Nida Jawed and Syeda Sana Ali

Editorial Board:

Dr Rubina Hakeem
Dr Salma Badruddin
Guidelines for contributors:

Type of article Word limit
Review articles 1000 – 1500
Original research 950 – 1000
Research Abstract 250
Brief reviews 250

In this issue:

PNDS activities at a glance
Understanding Functional Foods
Success story
Nutrition Events in 2016



Year 2015 has come to an end. Pakistan Nutrition and Dietetic Society (PNDS) is gradually expanding its horizon with both the Lahore and Islamabad Chapters. These are now fully active in conducting capacity building activities for their members as well. Let’s briefly go through the different activities PNDS has been engaged in the last three quarters.

A CNE was held on Saturday 25th April 2015 at The Kidney Centre (TKC), Karachi. Topic of the CNE was “Complementary Feeding” presented by Nusrat Akber, Registered Clinical Dietitian Indus Hospital, Karachi. More than 70 participants attended the session.

A two day workshop on “Communication Skills for Nutrition and Dietetic Professionals” was organized by PNDS at PNS SHIFA on 29th and 30th May 2015. Topics covered were Basic Communications Skills, Interpersonal Communication Model and Barriers to Effective Communication, Principles of Communication, Formal and Informal Writing Skills and How to write Business Letters, E-mails and Effective use of Microsoft PowerPoint to make Oral and Poster Presentations. 25 PNDS members attended the session. During the workshop attendants participated in different interactive activities and hands on training.

PNDS Islamabad Chapter conducted its first CNE this year on “Nutrition Care Process” on 3rd June 2015 at Shifa International Hospital, Islamabad. Presenter was Dr. Rezzan Khan, Head, Clinical Nutrition Department, Shifa International Hospital.

PNDS Lahore Chapter conducted CNE on 3rd June 2015 on “Complementary Feeding”, Thirty five members attended the session. The presenter was Amina Chughtai RD, Lecturer, in Department of Food Science and Human Nutrition at University of Veterinary & Animal Sciences, Lahore.

PNDS Annual General Body meeting and elections for Executive Committee was held on 8th August 2015. There were 103 eligible voters from Karachi from which only 46 members were present to vote. No ballot papers were discarded. Similarly there were 129 eligible online voters, out of this only 42 members voted.

The nine Executive Council members elected for the year 2015-2017 are:

President Fayza Khan
Vice president Nida Jawed
General Secretary Rabia Anwer
Joint Secretary Maryam Arif
Treasurer Rumella Masood

Executive Council members
Ghazala Zaman
Sumaira Nasim
Samina Adam
Sabeen Siddiqui

PNDS, Lahore Chapter conducted its 3rd CNE on “Nutritional Anemias” on 17th August 2015. A total of 30 people attended including RDs, members and non-members. Speaker Shifa Ali, RD, Clinical Dietitian. Ittefaq Hospital Trust, Lahore spoke about the alarming rise in anemia in Pakistan especially Iron deficiency anemia.

Pakistan Nutrition & Dietetic Society Islamabad Chapter organized its second CNE session on 1st September 2015, on “Role of Nutraceuticals in Type 2 Diabetes Management by Mrs. Hajra Ahmed, Asst. Professor, Home and Health Sciences Dept. Allama Iqbal Open University, Islamabad About 70 participants from different hospitals and educational institutes of twin cities Rawalpindi/ Islamabad attended the CNE including doctors, dietitians and Nutritionists.

7th Registered Dietitian Nutrition (RDN) exam was conducted in three cities Karachi, Lahore and Islamabad on 5th September 2015. A total 64 candidates appeared in the exam and only 50% were able to pass and become RDN . Members are required to work hard and develop their skills and knowledge in other disciplines of nutrition like Public Health and Food Service as well to succeed in the RDN exam.

PNDS Islamabad Chapter conducted its 3rd CNE on 2th Nov2015. Topic was“Novel Biomarker for Prevention and Treatment of CVD” and the speaker wasMr.Azmat Khalid Majeed, Consultant Clinical & Therapeutic Nutrition.

PNDS always aims to promote health awareness in general public. To celebrate “World Diabetes Day” a public awareness session on “Healthy Living with Diabetes” was arranged on 19th November 2015 in Collaboration with PNS Shifa. Around 120 participants including Naval personnel and their families attended the session. Dr. Salma. H.Badruddin gave a presentation on healthy living with Diabetes and Dr.Fareeduddin from DUHS, Karachi presented on Insulin Management in Type 2 Diabetes. The lectures were followed by question/ answer session. Participants were also given demonstration on my healthy diabetic plate and how to plan healthy breakfast, lunch, dinner and snacks. Free blood glucose tests and body composition analysis were also done. Healthy snacks were also arranged for the participants. The event was sponsored by Nestle Nutrition and Himont Company.

The new elected EC organized its first CNE on 31st October 2015 on “Infant and Young Children Feeding Practices in Pakistan”. Speaker was Sumaira Nasim, Senior Lecturer, School of Public Health, DUHS at the TKC. More than 75 participants attended the session.

The School of Public Health, DUHS in collaboration with PNDS organized a short course on “Public Health Nutrition: Sindh in Focus” from November 23rd -27th, 2015 for healthcare providers including, Registered Dietitians, Nutritionists, Physicians & Public Health professionals working in various health related organizations in Pakistan. Topics covered during the course included Policies & program on public health nutrition, Social determinants of nutrition wellbeing, Program planning and evaluation, Leadership, Multi-sectorial initiatives in nutrition etc. Around 27 participants attended the course of these 17 were PNDS members.


Group Photo : Public Health Nutrition Course School of Public Health, DUHS in collaboration with PNDS

So this is all till December 2015.Visit our website for updates and email your feedback and suggestions at

Understanding Functional Foods

By Amna Kashif (Registered Dietitian/Nutritionist)

Fibre husk for lowering cholesterol, grapefruit juice and green tea for weight loss, dark chocolates for a healthy heart and detox water to burn fat and flush the liver.
Sound familiar? These are a few of the many growing trends that have taken the public by storm in the past few years and before you know it everywhere people are swearing by these “super foods”.
As Dietitians/Nutritionists it is critical for us to be aware of these trends and the scientific evidence behind the claims. Dr. Rubina Hakeem spoke at the 2015 Nutrition Refresher Course about “Food Issues in Clinical Nutrition” effectively filling the gap by not only introducing the world of Functional Foods but also providing a road map for the future. The following article is thus inspired by the said talk.

Functional Foods – the concept:

The culture of food remedies or “totkay” (as we call them locally) is centuries old. Using black pepper, honey, cloves, turmeric, rice water, banana to cure flu, cough, weakness, stomach cramps and constipation is very common and at one time or another we all have benefitted from these remedies.
It is therefore not surprising that the Asia-Pacific Report of Food and Agriculture Organization of the United Nations (FAO) found that many countries of Asia consume several foods with functional attributes as part of their daily intake. These foods include green leafy vegetables, fruits, legumes, whole wheat and many condiments. Although the concept exists, there is no formal definition of functional foods in these countries.1

Functional foods – the science:

All foods serve to nourish the body and are therefore functional (affecting the way a part of the body works). However the advancement in technology has revealed that some food components, e.g. flavonoids, not traditionally considered nutrients can provide health benefits. The foods that contain these components are called functional foods.2

Functional Foods – definition:

Various government agencies, national and international organizations define functional foods (FF) in their own way (see table 1 for selected definitions).

Organization Definition
Japanese Ministry of Health, Labour and Welfare Foods for Specified Health Uses (FOSHU) refers to foods containing ingredient with functions for health and officially approved to claim its physiological effects on the human body. FOSHU is intended to be consumed for the maintenance/promotion of health or special health uses by people who wish to control health conditions.2
Academy of Nutrition and Dietetics (AND): Foods defined as whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels.2
Dietitians of Canada “Functional foods are foods that offer unique health benefits that go beyond simply meeting basic nutrient needs. Many also help to reduce chronic disease risk.”.3
Functional Food Centre (FFC)* “Natural or processed foods that contain known or unknown biologically-active compounds; which, in defined, effective non-toxic amounts, provide a clinically proven and documented health benefit for the prevention, management, or treatment of chronic disease.”4
*This is the most recent definition proposed at the 17th International Conference of FFC jointly organized with United States Department of Agriculture (USDA) and (Agriculture Research Service (ARS) in 2014.

In a nut shell all FF are:

  • part of a usual diet
  • are in food forms and
  • contain an ingredient which provides health benefit.3

It is therefore critical to understand that FF do not replace the need of a balanced diet, rather they provide added support when taken with a balanced diet.

Nutraceuticals, medical foods and dietary supplement are taken in the form of supplement, as formulated by a Physician and in non-food form respectively. Whereas, FF are only in food form, thus differing greatly from the afore mentioned products which are sometimes used interchangeably with the term FF.2

Categories of FF:

Due to the difference in definitions FF are categorized differently. Agri Food Canada3 divides them into: (i) Basic Foods, (ii) Processed foods with added bioactives and (iii) foods enhanced to have more of a bioactive component.

According to AND2:

Category Conventional Food Modified Food Food Ingredients that help synthesis of protective bacteria
Description Contain natural bioactive food compound Containing bioactive food compound through enrichment or fortification Such as indigestible carbohydrates
Examples Antioxidant vitamins in orange juice, isoflavones in soy-based foods, and probiotics* in yogurt n-3 fatty acids in margarine, spreads and eggs Oligosaccharides that provide substrate for growth of bacteria that act as prebiotics*
*Probiotics are “good” bacteria that help keep our digestive system healthy by controlling growth of harmful bacteria. Prebiotics are carbohydrates that cannot be digested by the human body. They are food for probiotics.

The attraction of FF for the public:

FF is gaining popularity amongst the public through increased awareness and concerns about health. The understanding that prevention is better than cure has led them to be conscious of their food choices and health benefits of food.

No data is available on popularity of functional foods amongst the Pakistani population, however it is common observation shows that general public have increased their intake of dried fruits and nuts. Drinking Ispaghol husk or flax seeds is gaining popularity along with lemon water and green tea to name a few.

Increasing health care cost and the growing trend to self-treat is also an important factor, giving consumers a greater control over their health at a reduced cost.2,6

Separating the fact from fiction:

As discussed above, the FF industry is gaining momentum2 but at the same time no single definition exists in both the developed2,3,4,5 and the developing countries1 to regulate the marketing of FF. Therefore it is imperative that Registered Dietitians/Nutritionists (RD/Ns) develop the skill to identify which FF claims are authentic and which are not in order to better guide the public.

A tool to help RDNs evaluate the FF is the Food Labelling Guide of the Food and Drug Association (FDA) and the “Summary of Health Claims Subject to Enforcement” document available on their website. Two examples of claims and FDA’s evidence statements7 relevant to the discussion are reproduced in table 2 below:

Psyllium Husk & Diabetes
Claim Statements
Psyllium husk may reduce the risk of type 2 diabetes, although the FDA has concluded that there is very little scientific evidence for this claim.
Walnuts & Heart Disease
Claim Statements
Supportive but not conclusive research shows that eating 1.5 ounces per day of walnuts, as part of a low saturated fat and low cholesterol diet and not resulting in increased caloric intake, may reduce the risk of coronary heart disease. See nutrition information for fat [and calorie] content.

Road Map for the Registered Dietitians/Nutritionists (8):

  • Stay Informed: Make a habit of visiting FDA, AND and EAL (Evidence Analysis Library of AND),, to develop and update your FF knowledge base. Share the knowledge you gain with your peers using platforms such as PNDS face book page, Newsletter and CNEs
  • Educate the consumer and the client: Guide the consumer, i.e. the public, using evidence based messages and do not let them be blinded by marketing messages. Emphasize that FF is effective when it is taken with a balanced diet.
  • Provide consultation to corporations: Provide the food industry sound scientific advice and assist them in developing products that truly benefit the public.

Conduct Research: It is the duty of each one of us to research, publish (articles/blogs) and present (in conferences) our findings in the field of FF to contribute to the expansion of FF knowledge base.

1. Food and Agriculture Organization of the United Nations Regional Office for Asia and the Pacific. Report of the Regional expert consultation of the Asia Pacific Network for food and nutrition on functional foods and their implications in the daily diet. Bangkok, Thailand: RAP Publication; 2004.

2. Crowe K, Francis C. Position of the Academy of Nutrition and Dietetics: Functional Foods. Journal of the Academy of Nutrition and Dietetics.[Internet]. 2013;113(8):1096-1103. [cited 25 October 2015]

3. Duncan A, Dunn H, Stratton L, Vella M. Translating knowledge into dietetic practice: a Functional Foods for Healthy Aging Toolkit. [Internet]. 2014 [cited 25 October 2015]. Available from

4. M. Martirosyan D, Singh J. A new definition of functional food by FFC: what makes a new definition unique?.Functional foods in health and disease [Internet]. 2015 [cited 25 October 2015];5(6):209-223. Available from:

5. Goetzke B, Nitzko S, Spiller A. Consumption of organic and functional food. A matter of well-being and health?.Appetite. 2014;77:96-105.

6. Ozen A, Pons A, Tur J. Worldwide consumption of functional foods: a systematic review. Nutrition Reviews. 2012;70(8):472-481.

7. US Food and Drug Administration. Summary of the Qualified Health Claims Subject to Enforcement Discretion.[Internet]. 2014 [cited 7 November 2015]. Available from

8. Hakeem R. Food Issues in Clinical Nutrition. Lecture presented at; 2015; RLAK Govt.College of Home Economics, Karachi.

My Career Story: Salma Halai Badruddin

I was born in Karachi at home; a relative assisted my mother in her delivery. I was my mother’s 9th child.In all we were 5 brothers and 6 sisters and we had a wonderful childhood. My married brothers all lived with us and some of their children were very close to my age. Together we put up dramas, organized sports and never got bored.

Neither of my parents had formal education. My father went to school till 5th class and my mother had never been to school. My father taught her to read and write after they were married. She was 13 and he was 19

We were a fun loving family. My parents played Monopoly, cards, and other local board games with us. To this day we remain a fun loving family: picnics, fishing, singing sessions and games are a regular feature of our extended family

Both my father and mother were remarkable people. They encouraged each child to maximize their talents. In spite of having 11 kids they kept up with each ones’ activities, so in the evenings when we congregated in the garden they would ask each child

“baita aaj aapka math test kaisa giya”

Baiti app ka to netball match tha- kaun jeeta?

Each child would be asked similar questions

They were also remarkable in that they changed with the times. My two elder sisters did their matric and then were schooled in the domestic arts. Both got married young. When I finished my matric at age 13 my mum had the same plans for me but I insisted that I would go to college. Some years later when my younger sister said she was tired of studies and would quit after her BSc. My mother came to me and said “Baiti un ko samjao aaj kal ka zamanay mai BSc kia hai kumaskum MSc to karlay”. I hugged her and said Ma you are remarkable.

At college I participated in every extracurricular activity possible- sports, drama, debate etc. As a result I did not do very well in Board Exams. Mrs. Ahmed one of my favorite teachers would keep telling me that if only I would concentrate on my studies I would be a first class student. Finally when I joined the Master’s program she said to me “Salma are you going to continue being Jack of all trades and master of none”. So I decided to pay more attention to my studies and thanks to Mrs. Ahmed I topped in the Masters exam. Of course my family was also behind me. From providing snacks for late night study sessions to going across town to borrow books from friends

By the time I finished my Masters my parents were all set for me to do my PhD. I went for my Phd on a 3 year Ford Foundation Scholarship although I was told that it would take 4 years to finish my PhD. I was very anxious as to what would happen when the scholarship ended but “Allah ka karam hai” I was given an Assistantship by the University plus I was awarded a Peace Scholarship for my efforts at creating an understanding of Islam and Pakistan by giving talks at various forums.

Coming back to Pakistan I was initially very disappointed. I had been sent to do my PhD so I could come back and start a specialized program of MSc in Nutrition. However while I was in the US the college had been nationalized and I had been transferred to Urdu College for women. Needless to say I never reported there for service.

I tried to set up a private practice as a consultant nutritionist but every doctor I talked to said something like “Why don’t you get in touch with PC or Sheraton.”

My lucky break came when I met Dr. Camer Vellani who was the Dean of AKU at a dinner. When he heard I had a PhD in nutrition he said ‘why don’t you start a private practice’. I told him the response of doctors and he said “I could really use your services.” Plus we will need you when the medical college starts, in the meantime why don’t you teach a course to the nurses so I don’t lose touch with you.

The next day I got a call from a lady who said Dr.Vellani had referred her to me for nutritional counselling. So there I was started in my private practice at home.

Then as soon as the Department was set up I got a call to come for an interview for a faculty position in the Department of Medicine. As my children were still young I agreed to a part –time position. I was told that even though my appointment was in Medicine I was free to work when any faculty member from any department who was interested in nutrition. I was also told that it was up to me to get nutrition into the medical curriculum. It was slow going but eventually I did manage to get nutrition into the curriculum. Getting started in research was easier as faculty in Pediatrics, Ob/Gyn, Surgery and Community Health Science gave me an opportunity to participate in research projects as a co-investigator. Soon I was writing proposals for funding myself and publishing research papers in international and local journals. During this time I got an opportunity to see the world – Korea, Australia, Canada, Malaysia, Thailand and Taiwan- to attend conferences to present my own research or as an invited speaker.

While working at AKU together with other colleagues from the RLAK College of Home Economics we formed the Pakistan Nutrition and Dietetic Society (PNDS) in 2003. The Society has grown in the last few years and we now have a chapter and Lahore and Islamabad

The rest is history I started as an assistant professor and retired as a full professor from AKU, thanks to the fore sight of one doctor.

Information regarding upcoming nutrition and dietetics events 2016

(Contributed by Sana Zaidi, student MSPH-Nutritional Sciences at School of Public Health, DUHS

    • 18th International Conference On Global Food Security (Singapore)
      January 7-8, 2016
    • Nutritional Genomics: Essential Basics For Nutrition And Health Professionals (Webinar)
      13 January 2016
    • International Conference On Food Security And Nutrition (New Delhi, India)
      February 7-8, 2016
    • The Probiotic Congress: Asia (Kuala Lumpur, Malaysia)
      29 February – 1 March 2016
    • 5th Annual Middle East Congress on Clinical Nutrition, Cairo, Egypt.
      March 22-24, 2016
    • 5th International Conference On Vitamin D Deficiency And Human Health (Abu Dhabi, UAE)
      24–25 March 2016
    • 3rd International Conference On Food Security And Nutrition – ICFSN (Amsterdam, Netherlands)
      23rd to 25th March 2016
    • Statistics For Nutrition Research 2016 ( London)
      19 April 2016
    • Malaysian Dietitian’s Association (MDA) and American Overseas Dietetic Association (AODA) conference,
      Kuala Lumpur,Malaysia. 26th-28th May 2016
    • Nutrifood 2016 : International Conference On Advances In Human Nutrition , Food Science & Technology (Toronto, Canada)
      June 26-27, 2016
    • 17th International Congress of Dietetics Granada Spain
      7th-10th September, 2016

Nutrition Courses and Trainings: