Food and Nutrition Situation in Malaysia

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Food and Nutrition Situation in Malaysia

• Assoc. Prof. Dr Rokiah Mohd Yusof
• Department of Nutrition and Dietetics
• Faculty of Medicine and Health Sciences
• Universiti Putra Malaysia
• 43400 UPM Serdang,
• Selangor, Malaysia

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Topics Present

• Introduction
• Nutritional Status
• Food supply and Dietary Pattern
• Diet Related Chronic Diseases
• Intervention Activities for Promoting Healthy
  Nutrition

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Introduction

• Increasingly more developing countries world wide
  are undergoing nutritional changes, which are
  characterized by manifestation of both under and
  over nutrition.
• While macronutrient and micronutrient
  deficiencies persist resulting in poor
  nutritional status and morbidity, the prevalence
  of overweight and obesity has been on the rise,
  in urban and rural areas in many countries.

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• Malaysia typifies a rapid developing country,
  which has undergone major demographic and
  socioeconomic changes since attaining
  independence in 1957.
• Fertility rates have declined from 6.94 in 1955
  to 2.94 in 2005
• Life expectancy at birth has increased from 48.5
  (1955) to 73.1 years (2005)

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• Urbanization growth rate at 3 in recent years
  resulted in 62 of the present population, which
  estimated as 25.35 millions in 2005, living in
  urban areas.
• The country also experienced epidemiological
  transition shifts from a situation with
  predominance of infectious disease to one
  distinguished by growing prevalence of chronic
  and degenerative disease
• In recent years, coronary heart disease, cancers
  and stroke constitute the leading causes of
  mortality, accounting to more than 40 of total
  death.

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Nutritional Status

• Prior to the 1960s, severe forms of protein
  energy malnutrition, anemia and vitamin A
  deficiency were widespread especially in children
  and women from poor rural areas (Viswalingam,
  1928 Reed, 1940 IMR, 1957 Thomson, 1960).
• Since the 1980s, only mild to moderate forms of
  protein-energy malnutrition was found in
  children, manifested as under weight (too thin
  for age), stunting (too short for age) and
  wasting (too thin for height).

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• Such growth deficits are more common in poor
  households and interior communities that have low
  access to adequate and nutritious food and health
  facilities.
• The prevalence of underweight and stunting in
  poor community has been on the decline in recent
  years.
• In agriculture communities, such in rice growing
  areas, estates, rubber and coconut smallholdings,
  the prevalence of underweight and stunting among
  children below 6 years old in the 1980s was 37
  and 43 respectively (Chong et al, 1984).

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• In the 1990s, studies found lower underweight,
  and stunting ranging from 31-33 and 26-27
  respectively (Khor and Tee, 1997)
• According to the Ministry of Health (MOH) and
  UNICEF survey nationwide in 1998-2000 among
  children less than 6 years, 19.2 were
  underweight (lt -2SD weight-for-age) and 16.7
  stunted (lt -2SD height-for-age)

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• Based on surveillance data of MOH, the overall
  prevalence of underweight among children aged
  below 5 years was 17.3 in 2004 compared to 25
  in 1990.
• The prevalence of overweight in children is much
  lower than the adults.

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• The 1998-2000 MOH/UNICEF Survey recorded 2.9
  male and 2.2 female children below 6 years as
  overweight , with higher prevalence in
  metropolitan (3) and large urban areas (2.8)
  than in rural areas (1.8).
• The MOH surveillance data showed that in 2004,
  4.1 of children aged 5 years were overweight.

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• Meanwhile in adults, the problem of underweight
  has also been reported in urban and rural areas.
• NHMS II (1996) determined the overall prevalence
  of underweight in adults as 25.2, while other
  studies on smaller numbers of subjects reported
  underweight rates for men and women at 7 and 11
  in urban, and 11 and 14 in the rural areas,
  respectively.

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• In relation to infant feeding, the overall
  prevalence of ever breastfeeding remains high at
  88.6 according to the Second National Health and
  Morbidity Survey (NHMS II) in 1996, and compared
  to the Malaysian Family Life Survey (MFLS)
  prevalence of 85 in 1988.
• However the duration of breastfeeding appears to
  have declined from 6 months (MFLS) to 4.5 months
  (NHMS II)
• NHMS II also noted that the prevalence of
  exclusive breastfeeding through the first 4-6
  months was low at 29 and bottle-feeding was high
  at 86 among children aged below 2 years.

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• While the country is still addressing
  under-nutrition problems, health problem
  associated with over nutrition have been on the
  rise in recent decades.
• The NHMS II (1996) covering 28,737 adults aged 20
  and older, found that 20.1 and 21.4 of the men
  and women are overweight (Lim, 2000)

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• The same survey also reported 4 of the men and
  7.6 of the women were obese (BMI exceeding
  30kg/m2).
• Prior to the 1990s, overweight and obesity were
  more often reported among the urban adults and
  children only (Ismail et al, 1995 Bong and
  Safurah, 1996) but this problem has caught up
  with the rural adults too.

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• A survey of 4,595 adults from agriculture and
  fishing communities found that 19.8 of the men
  and 28 of the women to be overweight, whilst
  another 4.2 and 11.1 of the men and women
  respectively were obese (Khor et al, 1999).
• Obesity of the poor may be due to various reasons
  including excess reliance on cheaper sources of
  energy, such as rice, flour, roots and tubers,
  increased sedentary lifestyles, and putting on
  excess weight during pregnancy.

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Food supply and Dietary pattern

• Fundamental changes in food supply patterns
  emerged in recent decades.
• These changes have led to not only increasing
  amounts of food available but also to changes in
  the composition of the diet.

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• Important changes in food consumption between
  1967 and 2000 are summarized below for energy and
  major foods
• a) Total calories available for consumption has
  increased by 21.3 over the past three decades,
  from 2,407 calories to 2,919 calories per person
  per day
• b) Percentage of energy from fat increased from
  17.9 to 26.9 with about 60 from vegetables
  oil and 40 from animal products.

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• c) The proportion of calories from cereals has
  declined from 57.1 of the total calories to
  43.6.
• d) The proportion of calories from animal
  products increased from 11.2 of total calories
  to 19.4
• e) Poultry meat availability rose over six fold
  from 5.7kg to 36.7kg per person per year.

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• f) Availability of eggs (hen) has almost tripled
  from 5.0kg per person per year to 14.4 kg.
• g) The amount of milk available per person per
  year has risen from 28.9kg to 52.7kg.
• h) Availability of fish and other seafood has
  doubled from 29.5kg to 57.9kg per person per
  year.
• i) The amount of available sugar (raw) and
  refined) has increased from 28 kg to 47.6kg per
  person per year.

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• Some studies found that the lower income groups
  tend to depend on a limited range of food items
  for calories such as rice, flour (like noodles,
  local cakes and snacks), cooking oil and sugar.
• Rice and other cereals followed by chicken and
  fish constitute their main source of protein.

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• In contrast, people in higher income tend to
  consume a wider variety of food including more
  dairy products, fruits and vegetables.
• Past studies also showed that the vulnerable
  groups, comprising growing children, pregnant and
  lactating mothers and the elderly, from
  low-income communities generally consume
  inadequate calories, iron, calcium and the B
  vitamins (Soon Khor, 1995 Poh et al, 1996
  Suriah et al, 1996 Chee et al, 1997).
• Adequate consumption of vitamin A and C tends to
  vary depending upon day to day and seasonal
  fluctuations in the intake of fruits and
  vegetables.

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Diet-Related Chronic Diseases

• Malaysia faces the challenges arising from
  increasing prevalence of the diet-related chronic
  diseases including cardiovascular disease (CVD).
• Heart diseases have been the leading cause of
  deaths in Malaysia since 1970s, and together with
  the death due to cerebrovascular disease,
  constitute 28 of all medically certified deaths.

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• Although CVD mortality rate in Malaysia ranks
  lower than that in other Asia Pacific region
  (Khor, 2001), the upward trend of the prevalence
  of its risk factors is a matter of public health
  concern.
• The major risk factors are hypertension,
  diabetes, dislipidaemia and obesity.

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Hypertension

• Overall prevalence of hypertension among adults
  aged 30 years and above in all states in Malaysia
  was 29.9 with self reported hypertension at 14
  and undiagnosed hypertension at 15.9 (NHMS II)
  (MOH, 1997)
• In comparison, the NHMS 1 in 1987 had reported
  14 of adults 25 years and above had elevated
  blood pressure.

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Diabetes

• The prevalence of diabetes appears to have risen
  from 6.3 in 1987 (NHMS1) to 8.7 in 1997 (NHMS
  II).
• Given that the population of Malaysia in 1996 was
  about 21 million, the total number of diabetics
  is estimated at 1.7 million.

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Dyslipidaemia

• Dyslipidaemia, the most commonly assessed
  component being total cholesterol or
  hypercholesterolemia.
• In comparing some studies, Ng and co-researchers
  (2000) noted that the mean total cholesterol
  values of the rural adults in 1990s were edging
  closer to the levels of their urban counterparts.

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• The prevalence of hypercholesterolemia (total
  cholesterol gt6.2 mmol/L) among rural males
  (n3153) and females (n4033) were 11.6 and 16
  respectively.
• There is an upward shift in the mean total
  cholesterol values for the rural communities of
  various age groups during the 1980s and 1990s.

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Intervention Activities for Promoting Healthy
Nutrition

• Programs and activities aimed at the promotion of
  sound dietary practices towards the achievement
  of good nutritional and health status are carried
  by Ministry of Health, while others including
  Ministries of Agriculture, Rural Development and
  Education.
• Universities and research institutes contributes
  in research, training and providing extension and
  consultancy services.

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• Professional societies like the Nutrition Society
  of Malaysia and Malaysian Dieticians Association
  are active in advocacy and dissemination of
  information to the public.

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National Plan of Action for Nutrition

• The formation of the National Coordinating
  Committee on Food and Nutrition of Malaysia
  (NCCFN) in 1995 has stimulated active
  collaboration among the various agencies and
  groups which carry out nutrition and related
  activities, towards achieving the general
  objectives of improving nutritional status and
  health of Malaysians.

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• The NCCFN was formed following the FAO/WHO
  International Conference on Nutrition in Rome in
  1992, whereby members countries were committed to
  developing their own National Plan of Action for
  Nutrition (NPAN) (Ministry of Health, 1996).
• The NPAN of Malaysia was completed in 1996 and
  one of its major recommendations was the
  formation of the four Technical Working Groups
• Research, Training, Dietary Guidelines and
  Nutrition Policy

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• Each Technical Working Groups (TWG) comprises
  members from agencies wth nutrition activities
  including universities, the private sector,
  government and non-government organizations.
• Some of the activities of TWG are
• 1) The research TWG coordinated a workshop in
  identifying the priority research areas in
  nutrition under the 8th Malaysian Plan
  (2001-2005).
• 2) The Training TWG developed five nutrition
  modules and has been conducting training courses
  for trainers and community workers from various
  agencies.
• 3) The Dietary Guidelines TWG published the
  Malaysia Dietary Guidelines in 1999, and is
  coordinating efforts in revising the Malaysian
  recommended dietary allowance (RDAs)
• 4) The Policy TWG has the task of preparing an
  important milestone namely, The National
  Nutrition Policy of Malaysia, launched in 2003.

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Malaysian Dietary Guidelines

• Dietary guidelines are useful principles to guide
  consumers in making informed choices in food
  selection and feeding practices.
• There are 8 principles in the Malaysian Dietary
  Guidelines

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• Enjoy a variety of foods.
• Maintain healthy body weight by balancing food
  intake with regular physical activity.
• Eat more rice and other cereals products,
  legumes, fruits and vegetables.
• Minimize fat in food preparation and choose foods
  that are low in fat and cholesterol.
• Use small amounts of salts and choose foods low
  in salt.
• Reduce sugar intake and choose foods low in sugar
• Drink plenty of water daily
• Practice and promote breastfeeding.

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• Ministry of Health through its Division o Family
  Health Development implements several nutrition
  intervention programs and activities as follows
• Supplementary Feeding Programs
• MOH provided full cream milk powder to
  undernourished children under 7 years of age,
  pregnant and lactating mothers.
• Ministry of Education provides subsidized milk
  and free meals to primary school children from
  poor families.
• The Ministry of Rural development through its
  KEMAS programs provide meals for preschool
  children, and food assistance to poor families.

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• Multiple Nutrient Supplementation.
• The Ministry of Health distributes iron,
  folic acids, vitamin C and B complex to pregnant
  women during their antenatal check-ups.
• Nutrition Rehabilitation Program.
• Moderately and severely malnourished childen
  under 7 years of age are given food aid
  comprising essential items such as rice,
  anchovies, biscuits, milk powder, cooking oil,
  sugar and green gram worth RM 60 every month.

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• Iodine Deficiency disorder Control program.
• Several approaches were used towards the
  effective control of iodine deficiency disorder
  (IDD) in Sabah, Sarawak and Peninsula Malaysia
• Legislation requiring that all salt sold in IDD
  gazetted areas be iodized.
• Free distribution of iodized slat by government
  clinics.
• Use of iodinators to iodized water supplied by
  gravity-freed system to villages and boarding
  schools in rural areas

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Nutrition Education and Health Promotion

• 1) The Ministry of Health through its network of
  hospitals, health centers and family health
  clinics as well as at the community level
  routinely conducts nutrition education and food
  preparation classes.
• 2) The Ministry of Health coordinating an annual
  Healthy Lifestyles Campaign since 1990 with
  nutrition either directly or indirectly as the
  central theme in the Healthy Eating Campaign
  (1998), Cardiovascular Diseases (1991), Food
  Safety (1993), Cancer (1995) and Diabetes
  mellitus (1996), and Healthy Family (2001)

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• 3) The Ministry of Education includes aspects of
  nutrition in the primary and secondary curriculum
  e.g. in Physical and Health education and Home
  Economics subjects.
• 4) The Ministry of Rural Development through
  KEMAS carries out classes and home visits
  involving food and nutrition components.
• 5) Professional societies such as the Nutrition
  Society of Malaysia, Malaysian Dieticians
  Association, Malaysia Association for the Study
  of Obesity and the Heart foundation of Malaysia
  are involved in disseminating information on food
  and nutrition and health to members and general
  public through talks, seminars, and exhibitions.

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Conclusion

• From the above overview, it can be seen that
  Malaysia has a multitude of nutrition and public
  health intervention programs and activities,
  aimed at the promoting healthy eating and
  nutrition of the general population as well as
  specific vulnerable groups (e.g. the poor, the
  malnourished, and the children below 7 years of
  age).
• Whatever future programs plan for promoting
  healthy eating could be incorporated into the
  existing programs carried out in the various
  ministries and agencies.

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• Thank you
• for your attention.