Transcript Food and Nutrition Situation in Malaysia

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
Topics Present





Introduction
Nutritional Status
Food supply and Dietary
Pattern
Diet Related Chronic
Diseases
Intervention Activities
for Promoting Healthy
Nutrition
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.

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)




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.
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).



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).


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 (< -2SD weight-for-age) and 16.7%
stunted (< -2SD height-for-age)

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.


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.


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.



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.


While the country is still addressing undernutrition 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)


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.


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.
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.
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.

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.
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.


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.



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.
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.


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.
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.
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.
Dyslipidaemia


Dyslipidaemia, the most commonly assessed
component being total cholesterol or
hypercholesterolemia.
In comparing some studies, Ng and coresearchers (2000) noted that the mean total
cholesterol values of the rural adults in 1990s
were edging closer to the levels of their urban
counterparts.


The prevalence of hypercholesterolemia (total
cholesterol >6.2 mmol/L) among rural males
(n=3153) and females (n=4033) 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.
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.

Professional societies like the Nutrition Society
of Malaysia and Malaysian Dieticians’
Association are active in advocacy and
dissemination of information to the public.
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.


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
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.

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:
1)
2)
3)
4)
5)
6)
7)
8)
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.


1)
2)
3)
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.


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.

1)
2)
3)
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
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)



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.
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.
Thank you
for your
attention.