Lecture 6:

Nutrition Monitoring, Status

and Research in Malaysia
Outline
1. Understanding the Food Security & Nutrition
Security
2. Learning about Nutrition Monitoring in
Malaysia
3. Understanding the Nutrition Situation in
Malaysia
4. Understanding Changes in Dietary and
Behavior
5. Learning about Nutrition Policy
6. Learning about Nutrition Programs and
Services
7. Learning the Nutrition Research Priorities (10th
MP)
 Food Security
and
Nutrition Security
Food security
FAO definition:

exists when all people, at all times, have physical, social and economic
access to sufficient, safe and nutritious food to meet their dietary needs
and food preferences for an active and healthy life.
http://www.who.int/trade/glossary/story028/en/

In other words: access by all people at all times to enough

food for an active and healthy life.

Food insecurity
limited or uncertain ability to acquire or consume an adequate
quality or sufficient quantity of food in socially acceptable ways.
Who are the Food Insecure?
• The poor
• The working poor
• The young
• Ethnic minorities
• Older adults
• Inner-city and rural dwellers
• The homeless
Poverty is the highest identified
reason for food insecurity and
hunger.
 Problem of Poverty:

1) Food is available but not accessible to the poor who

don’t have land or money

2) 16% of the developing world’s population suffer from

chronic undernutrition,
• Found in countries that can neither produce enough
food nor earn enough to import it

3) Nearly 25% of the world’s population suffers some

form of malnutrition.

4) https://www.youtube.com/watch?v=1Nuw7zDS7aQ
Nutrition security
• Access by every member of the household or
community to adequate and quality diet
- to enable optimum growth and development
- to prevent under and overnutrition

Food System
• includes all processes and infrastructure involved in feeding
a population:
 growing,
 harvesting,
 processing,
 packaging,
 transporting,
 marketing,
 consumption, and
 disposal of food and
food-related items
Nutrition Monitoring
in Malaysia
• Lifestyle and dietary habits of Malaysians over the last
decade were influenced by family and social
environment, which affected nutritional status of the
community (children and adults).

• Reduced physical activity and changes in the diet are

the contributing factors of overweight and obesity
among children and adults (Mohd Ismail et al., 2009).

• National nutrition surveys are carried out to set up

baseline and social diagnosis data. For example:

1) Malaysian Adult Nutrition Survey (MANS) (18 -59

years old)
2) National Health and Morbidity Survey (NHMS II,
1996 and NHMS III, 2006)
3) Malaysian non communicable diseases (Malaysia
NCD Surveillance, 2006).
In previous studies, anthropometry was used as a
tool to measure the nutritional status of the
population.

There is limited data on several age groups in the

Malaysian population such as:
• adolescents
• elderly
• vulnerable groups (infants, toddlers, preschoolers,
pregnant women, elderly and indigenous groups).
There is also an emerging needs on the behavioural and social
economic issues such as:
• risk behavior and social economic factors on food
consumption
• national study on food and nutrition security.

The current food composition table in Malaysia consist of 580

of raw foods and 203 of cooked food items (Tee et al., 1997).

An update on the database of dietary intake of all target groups

in Malaysia is greatly needed to assist relevant policy makers,
stake holders and ministries (for example Ministry of Health,
Ministry of Education, Ministry of Women, Family and
Community
Development and Ministry of Agriculture ) to develop
appropriate guidelines.
The suggested updated version of food composition
table in Malaysia shall include data some micronutrients
such as:

1. Zinc,
2. selenium,
3. vitamin D,
4. vitamin B12,
5. folic acid,
6. fibre
7. fatty acids
8. Iodine.
Nutrition Situation
in Malaysia
1) Food consumption in Malaysia
 The consumption of calories from animal products is
increasing and a decline in calorie from cereals.

 An increase in the proportion of calories from fat.

 Limited varieties of food consumption in LSE groups.

 Low intake of micronutrients in vulnerable groups.

 Breastfeeding(BF): exclusive BF rate is low; not sustained

and inappropriate complementary feeding.

 Emerging issues: functional foods, genetically modified food

(GMF), health claims on foods and dietary supplements.
2) Nutritional status in Malaysia

 Protein-energy Malnutrition (PEM) (underweight,

wasting and stunting) still prevails among children from
low socio-economic families in both rural and urban
areas.
 Poverty is still a major determinant of health and
nutritional status.

 Micronutrient deficiencies: anaemia persist among

young children, adolescent girls, pregnant women and
the elderly.

 Iodine Deficiency Disorder (IDD) remain a significant

problem in Sabah, Sarawak and some areas in
Peninsular Malaysia (including in islands).
Nutritional status in Malaysia(cont.)
 Imbalanced diets coupled with a sedentary
lifestyle lead to an increase in the prevalence of
risk factors for diet-related non-communicable
diseases
 e.g. obesity, noninsulin-dependent diabetes
mellitus (NIDDM), CVD and certain types of cancer
 Urban and rural areas are affected
Changes in Dietary and
Behaviour
Nutrition Policy in
Malaysia
Implementation
 Implementation is under the scope of the
National Food Safety and Nutrition Council,
MOH (Majlis Keselamatan Makanan dan
Pemakanan Kebangsaan).

 The national Coordinating Committee on Food

and Nutrition (Jawatankuasa Penyelaras
Makanan dan Pemakanan Kebangsaan) will
serve as the coordinator and technical advisor.

 The policy will be translated into effective and

viable plans through the revised National Plan
of Action for Nutrition (NPANM).
Monitoring and evaluation
1. To ensure that the policy will be
implemented as planned and the
objectives are met.

2. To identify the problems and constraints

in implementing the policy.

3. To improve the management and

performance of the policy.
National Plan of Action for
Nutrition III (NPAN III) 2016-
2025
Nutrition Program and
Services in Malaysia
 Maternal and child health clinics
 Baby friendly hospital initiative
 Food basket program
 Code and ethics for marketing infant
nutrition and related products
 Nutrition counseling at child and
maternity clinics
 Schools
 School feeding program
 Kantin sekolah sihat
 School milk program
 Community
 Malaysian dietary guidelines
 Nutrition information centre
 Nutrition counselling at health clinics
 Dapur sihat masyarakat
 Prevention of IDD
 Institution
 National service camp (PLKN)
 Elderly institution
Jabatan Kesihatan Negeri Terengganu
(Unit Pemakanan)
Perkhidmatan / Aktiviti Unit
 Pengawasan Taraf Pemakanan Kanak-Kanak
 Pengawasan Anemia di Kalangan Ibu Mengandung
 Program Pemulihan Kanak-Kanak Kekurangan Zat Makanan (PPKZM)
 Program Pemulihan Ibu Mengandung Termiskin (PPIMT)
 Program Makanan Tambahan Susu Tepung Penuh Krim (STPK)
 Program Kawalan dan Pencegahan Gangguan Akibat Kekurangan
Iodin
 Promosi Penyusuan Susu Ibu (PSI)
 Initiatif Hospital Rakan Bayi
 Pengawasan Kod Tata Etika Produk Susu Formula Bayi
 Program Dapur Sihat Masyarakat (DSM)
 Perkhidmatan Pemakanan di Klinik Kesihatan
 Kempen Cara Hidup Sihat (Makan Secara Sihat)
 Pusat Maklumat Pemakanan
Nutrition Research Priorities in Malaysia
for the 10th Malaysia Plan (2011-2015)
Area 1: Infant Feeding and Complementary Feeding Practices
Area 2: Monitoring of National Nutritional Status
Area 3: Food Intake and Healthy Dietary Practices Across the
Lifespan
Area 4: Macro and Micronutrient Excesses and Deficiencies
Area 5: Overweight and Obesity
Area 6: Diet-related Non-Communicable Diseases (NCD)
Area 7: Food Composition Database for Nutrient and Non-
nutrient Components

http://nutrition.moh.gov.my/buku/
Nutrition Research Priorities in
Malaysia for the 11th Malaysia Plan
(2016-2020)
Area 1: Maternal, Infant and Young Child
Nutrition
– Research is much needed on
• Various aspects of maternal diet and nutritional status during
pregnancy, infant and complementary feeding practices
• Intakes of energy and nutrients as well as dietary patterns of
pregnant women,
• Consequences of maternal nutritional status, dietary
adequacy in infants and young children
• Infant and young child feeding practices of minority
population groups, low birth weight and premature infants is
needed

– The process of developing new strategies that could

enhance the health and nutritional status of pregnant
women, infant and young children in Malaysia can be
undertaken if only adequate information is available
through related research
Area 2: Monitoring and Evaluation of National Food
and Nutrition Security, Nutritional Status and
Programmes

 Existing nationwide surveys on nutritional status of

the population
 Malaysian Adult Nutrition Surveys (MANS) (2002/2003 & 2014)
among adults aged above 18 to below 60 years of age.

 National Health and Morbidity Surveys have also been carried out
namely, NHMS I (1986), NHMS II (1996), NHMS III (2006), NHMS 2011
(2011) and NHMS 2015 (2015).

 large scale studies on nutritional status of preschool children

(Mohd Nasir et al., 2012; Norimah et al., 2014), school children
(Ismail et al., 2009; Balkish et al., 2013) have also been published
– Reremains gaps at the national level for data on a number
of population groups
 Adolescents, infants, toddlers,
 Pregnant women,
 The elderly and
 Indigenous population groups

– A need to strengthen the monitoring and evaluation of

 National food and nutrition security
 Nutritional status and
 Nutritional programmes

– Emerging needs
 To evaluate behavioural factors influencing the
nutritional status
 To determine social and economic factors influencing
food and nutrition security
Area 3: Life Course Food Intake and Dietary
Practices
Focus in this NRP area
1. Understanding food intake and dietary practices among
various age groups
 a need to assess the impact of nutrition on healthy growth
and development
 More researches are needed on nutrition related
behaviour among various age groups
 More researches are needed on the variability in
individuals in response to diet and food intakes

2. Evaluating the effectiveness of interventions to

promote healthy dietary practices among various age
groups

3. Understanding the consequences of unhealthy dietary

practices on health status in later life.
Area 4: Macro and micronutrients:
excesses and deficiencies

 Strengthen epidemiological understanding of the

extent of micronutrient deficiencies
 A need for national assessment on the prevalence of
dietary intake and blood status of micronutrient
deficiencies of all age groups
 Evaluating the impact of current nutritional
strategies and developing other strategies,
including fortification to improve micronutrient
status
 Develop innovative methods to tap on indigenous
foods as sources of micronutrients
 Enhance delivery system
 Improve programme coverage for target groups
Area 5: Overweight and obesity

 Improve understanding
 Epidemiology: definition (cut-off points), obesity and CVD
risk factors, early nutrition- adult adiposity, economic and
social costs
 Etiologies: dietary intake, metabolic susceptibility- E
expenditure, adult onset & childhood obesity, physical
activity, genetics of obesity
 Improve effectiveness
 Management
 Obesity prevention and intervention: work-place, community setting, school-based

 Management of obesity
 Pharmacology
 Clinical setting
 Surgical

Policy and environment: economic and social benefits

 Develop new modalities
 Effectiveness of obesity prevention and management
 Diagnosis
 Treatment: functional foods, herbal, novel and practical
intervention strategies
Area 6: Diet-Related Non-Communicable Diseases
(Cancer, Diabetes and Cardiovascular Disease)
 Strength epidemiological data
 Prevalence of NCD in relation to nutritional status, dietary
behaviour, lifestyle
 Evaluate community intervention programs
 Evaluate intervention program at the community level
 Evaluate intervention programs at the workplace
 Evaluate school-based intervention programs
 Evaluate nutrition promotion in wellness clinics
 Evaluate clinical nutrition interventions
 Evaluate clinical management
 New modalities: diagnostic and treatment
 Functional foods, herbs, dietary supplements
 Nutrigenomics
 Develop novel techniques
Area 7: Food Composition Database
– Update current FCD
• Collate existing data for macro & micronutrients
and non-nutrients

– Add new data to FCD

• Macro and micronutrients, Rates of nutrients
retention
• Cooked dishes, Collate data from food
manufacturers
• New food items from east coast, Sabah & Sarawak
• Varieties of food items, functional ingredients, anti-
nutrients

– Establish contaminants & additives database

• Food additives, heavy metals, mycotoxins, residues
(pesticides, veterinary drugs), industrial-by
products
• Other contaminants

– Improvement to methodologies
• Identification, adaptation, validation of methods
• Establishment of inter-lab variations