1.Nutritional Status of Malaysian Primary School Children Aged 8-10 Years: Findings from the 2008 National IDD Survey
Ahmad Ali Zainuddin ; Rusidah Selamat ; Azli Baharudin ; Suhaila Abdul Ghaffar ; Norsyamline Che Abdul Rahim ; Tahir Aris
Malaysian Journal of Nutrition 2013;19(2):149-161
Introduction: Child malnutrition continues to be a major public health problem
in developing countries. This study aims to determine the current nutritional
status of Malaysian school children using the anthropometric indicators of weight
for age (WAZ), height for age (HAZ), and body mass index for age (BAZ).
Methods: A nationwide school-based survey was undertaken in all Malaysian
states and territories, which included 18,078 children aged 8-10 years attending
445 primary schools. The software WHO AnthroPlus was used to calculate zscores
for the nutritional status (WAZ, HAZ and BAZ) of the target population
relative to the World Health Organization (WHO) 2007 reference. Results: The
national prevalence of underweight among school children was 13.6% and in
rural areas, this rate was nearly double that of urban areas. The national prevalence
rate for stunting was 10.9%, double among rural school children compared to
their urban counterparts. As for thinness, the national prevalence was 6.5%.
Using the WAZ indicator, we found that the national prevalence of overweight
children was 7.6%. Additionally, we found that urban areas showed a higher
prevalence of overweight children (8.8%) than rural areas (5.9%). Conclusion:
The findings of this study indicate that Malaysian school children face the burden
of malnutrition, suffering from both undernourishment and overweight.
Malaysia must make a concerted effort to overcome the problems of malnutrition
among children.
2.Iodine Deficiency Disorder and Goitre among School Children in Sarawak -A Nationwide Study
Lim Kuang Kuay ; Chan Ying Ying ; Ahmad Ali Zainuddin ; Teh Chien Huey ; Hasimah Ismail ; Lim Kuang Hock ; Kee Chee Cheong
International Journal of Public Health Research 2014;4(1):419-424
Iodine deficiency disorders (IDD), is one of the most important micronutrient deficiencies which has multiple adverse effects on growth and development. The aim of this study was to determine the prevalence of IDD among school children and to elucidate the distribution of iodized salt at household level in Sarawak, East Malaysia. This cross-sectional study was conducted among school children aged 8 to 10 years in 2008. A multi-stage probability proportionate to population size (PPS) cluster sampling method was used to obtain a representative state sample of 1200 school children. Spot urine samples were collected for the determination of urinary iodine concentration while the iodine content in salt was determined using field rapid test kits. The thyroid status was determined by palpation. Response rate was 92.0% (n=1104/1200). The prevalence of goitre among school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The median urinary iodine concentration (UIC) among the school children was 102.1 µg/L (IQR, 62.3-146.5 µg/L). Urban children had significantly higher median UIC of 109.3 µg/L (IQR, 72.4-159.0 µg/L) than their rural counterparts [91.9 µg/L (IQR, 55.7-140.2 µg/L)]. The salt samples tested by rapid test kit (RTK) showed only 46.0% of household salt contained iodine. The present study revealed that the population in Sarawak were of borderline iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD control programmes need to encourage and advocate the consumption of iodized salt in order to eliminate IDD-related health problems in Sarawak.
Congenital Hypothyroidism
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Goiter
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Schools
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Child
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Malaysia
3.Food Insecurity Situation In Malaysia: Findings From Malaysian Adult Nutrition Survey (MANS) 2014
Mohamad Hasnan Ahmad ; Rusidah Selamat ; Ruhaya Salleh ; Nur Liana Abdul Majid ; Ahmad Ali Zainuddin ; Wan Azdie Mohd Abu Bakar ; Tahir Aris
Malaysian Journal of Public Health Medicine 2020;20(1):167-174
Food insecurity affects food intake, and it could prevent an individual from consuming enough nutritious food to support and maintain health. The aim of this paper is to determine the prevalence and factors influencing food insecurity among Malaysian households. In 2014, the Malaysian Adult Nutrition Survey (MANS) was carried out, and one of the components measured was food insecurity. Six out of sixteen questions from the food security core-module questionnaire were adopted and answered by 2962 adults. The results showed that about 25.0% adult experienced food quantity insufficiency, 25.5% had food variety insufficiency, 21.9% practised reduced size of the meal, and 15.2% skipped main meal due to lack of money to spend on. For the parents, 23.7% only rely on cheap food to feed children, and 20.8% could not afford to purchase various foods to feed their children. Location, strata, race, level of education, working status and household income shows significant difference while none of the nutritional status components found to be difference in all six parameters of food insecurity measured. Logistic regression with adjusted odds ratios discovered race, education level and household income were related to risk to all six parameters of food insecurity. In conclusion, food insecurity can be a serious problem in Malaysia. An effective and comprehensive effort by the government in terms of policy solution is required to increase education level and ensure an adequate income for every household. Therefore, future research should focus on some of those promising policy solutions and at the same time, study the other possible underlying factors that may lead to food insecurity.
Food Insecurity
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Malaysia
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Adult
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Nutrition Survey
4.Under-reporting of energy and nutrient intake is a persistent issue in the Malaysian Adult Nutrition Surveys
Ahmad Ali Zainuddin ; Norazmir Md. Nor ; Safiah Md Yusof ; Adriana Irawati Adriana Irawati ; Tahir Aris Tahir Aris ; Foo Leng Huat
Malaysian Journal of Nutrition 2019;25(2):261-271
Introduction: Under-reporting of energy intake is a common cause of bias in nutritional studies. This study was aimed at examining the extent of under- reporting of energy intake and its related characteristics among respondents in the Malaysian Adult Nutrition Survey (MANS) 2003 and MANS 2014.
Methods: The present study analysed energy intakes of 9,624 adults aged 18-59 years from the MANS in year 2014 (2,890 respondents) and 2003 (6,734 respondents) using a single 24-hour diet recall. Basal metabolic rates (BMR) were calculated from the age- and gender-specific equations of Schofield. Under-reporting was defined as an energy intake:BMR ratio of <1.2 as proposed by Goldberg.
Results: Under-reporting was found to have increased significantly from 53% in 2003 to 61% in 2014. In both surveys, under-reporting increased with higher body mass index (BMI) and older age groups. It was higher among women than men, lowest among those with primary schooling or below, and those living in Peninsular Malaysia. It was higher among rural respondents in 2014 but higher among urban respondents in 2003. The intake of energy and micronutrients increased when under-reporters were excluded.
Conclusion: Under-reporting was prevalent in both the nationwide MANS, and is associated with BMI, age, gender, education level, location strata, zone. It is important to take this factor into account when assessing dietary intake in population-based studies.
5.Changes in energy and nutrient intakes among Malaysian adults: findings from the Malaysian Adult Nutrition Survey (MANS) 2003 and 2014
Ahmad Ali Zainuddin ; Norazmir Md. Nor ; Safiah Md Yusof ; Adriana Irawati Nur Ibrahim ; Tahir Aris ; Foo Leng Huat
Malaysian Journal of Nutrition 2019;25(2):273-285
Introduction: Monitoring changes in energy and nutrient intakes of the population over the course of time is essential to help healthcare providers develop effective dietary policies. The aim of this study was to assess the changes in the nutrient intake and Recommended Nutrient Intake (RNI) achievements by using the data obtained from the Malaysian Adult Nutrition Surveys (MANS) that were carried out in 2003 and 2014. Mis-reporting of energy intake was taken into account.
Methods: Dietary data were obtained from MANS 2003 and MANS 2014, which involved a combined total of 4,044 randomly selected respondents, aged 18-59 years, using a single 24-hour diet recall. Energy and nutrients calculations were based on the Malaysian Food Composition database using the Nutritionist Pro software. The results were compared against the RNI for Malaysia to assess dietary adequacy.
Results: The proportions of calories derived from macronutrients were within the recommendations for a healthy diet. The consumption of protein, fat, calcium, iron and vitamin A was significantly higher in 2014 than in 2003. The consumption of protein, iron, vitamin C, and vitamin A was found to exceed the RNIs in 2014. However, carbohydrate and sodium intakes had significantly decreased. Despite the decrease, sodium intake still exceeded RNI recommendations.
Conclusion: Signs of changing energy and nutrient intakes were found, including increases in protein and fat intakes since 2003, and decreased carbohydrates. This could be an alarming indicator of the tendency to eat energy dense food among the population.
6.Inadequate Iodine Intake among School Children in Terengganu- Findings from the National Iodine Deficiency Disorder Survey 2008
Lim Kuang Kuay ; Chan Ying Ying ; Ahmad Ali Zainuddin ; Teh Chien Huey ; Rusidah Selamat ; Kee Chee Cheong ; Hasimah Ismail ; Lim Kuang Hock
International Journal of Public Health Research 2013;3(1):198-203
Iodine deficiency is still prevalent worldwide and it is the main cause of goiter, thyroid dysfunction and mental retardation. The aim of the study was to determine the iodine status and goiter prevalence among the school children in Terengganu. The representative sample consists of 1163 primary school children aged 8-10 years old randomly selected from urban and rural schools in Terengganu using stratified systematic random sampling technique. Urinary iodine levels in spot urine were determined by in house modified micro-method while goiter assessment was carried out by palpation of thyroid gland. The status of iodine deficiency was determined by the median urinary iodine concentrations (UIC) and total goiter prevalence (TGP) in accordance with the WHO criteria. The result showed the median [inter-quartile range (IQR)] urinary iodine concentrations was 78.7µg/L (50.1µg/L -120.0µg/L) indicating the iodine intake was slightly lower than recommended range of 100 µg/L. The rural school children had a significantly lower Iodine levels (median UIC=72.4µg/L, IQR=46.7µg/L -113.0µg/L) than the urban school children (median UIC=87.7µg/L, IQR=54.5 µg/L - 127.5µg/L). The total goiter prevalence (TGP) was 5.7%. The prevalence of goiter was significantly higher in rural (TGP=6.9%) compared to urban areas (TGP=3.6%). The study revealed that school children in Terengganu showed mild iodine deficiency and the condition is more pronounced in children from rural areas. The findings emphasize the importance of intervention implementation, universal salt iodization to ensure sufficient intake of iodine among the Terengganu school children.
Congenital Hypothyroidism
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Child
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Thyroid Gland
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Goiter
7.Prevalence and Socio-Demographic Determinant of Overweight and Obesity among Malaysian Adult
Ahmad Ali Zainuddin ; Mala A Manickam ; Azli Baharudin ; Rusidah Selamat ; Kee Chee Cheong ; Noor Ani Ahmad ; Hatta Mutalip ; Rashidah Ambak ; Cheong Siew Man ; Mohamad Hasnan Ahmad ; Safiah Md Yusof ; Tahir Aris
International Journal of Public Health Research 2016;6(1):661-669
Overweight and obesity is a major public health problem in Malaysia. This study aims to determine the prevalence of overweight and obesity among the Malaysian adult population and their association with socio-demographic characteristics (gender, ethnic, and age groups). A total of 17,257 adults aged 18 years and older (8,252 men, 9,005 women) were assessed for BMI status, with a response rate of 97.8%, through a household survey from the National Health and Morbidity Survey (NHMS), conducted in all states of Malaysia in 2011. All socio-demographic factors were consistently associated with higher chance of being overweight (except gender and location) and obesity (except location and household income). The identified risk of overweight were Indian (aOR: 1.8, 95% CI: 1.2-2.8), aged 50-59 years (aOR: 2.8, 95% CI: 2.0-3.9), widower (aOR: 1.6, 95% CI: 1.3-2.0), subject with secondary education (aOR: 1.2, 95% CI: 1.0-1.4), Homemaker/unpaid worker (aOR: 1.3, 95% CI: 1.1-1.4), and with high household income group (aOR: 1.3, 95% CI: 1.2-1.6). The identified risk of obesity were women (aOR: 1.4, 95% CI: 1.2-1.6), Indian (aOR: 1.7, 95% CI: 0.9-3.2), aged 30-39 years (aOR: 3.6, 95% CI: 2.4-5.5), widower (aOR: 1.2, 95% CI: 0.9-1.6), subjects with primary education (aOR: 1.2, 95% CI: 0.9-1.6), Homemaker/unpaid worker (aOR: 1.3, 95% CI: 1.1-1.6), and with middle household income group (aOR: 1.3, 95% CI: 1.2-1.6). Our data indicate a high prevalence of overweight and obesity in the population. Several sociodemographic characteristics are associated with both overweight and obesity. This study highlights the serious problem of overweight and obesity among Malaysia adults. Documentation of these problems may lead to research and policy agendas that will contribute both to our understanding and to the reduction of these problems.
8.Malnutrition among Malaysian Adolescents: Findings from National Health and Morbidity Survey (NHMS) 2011
Azli Baharudin ; Ahmad Ali Zainuddin ; Rusidah Selamat ; Suhaila Abdul Ghaffar ; Khor Geok Lin ; Poh Bee Koon ; Norimah Abd Karim ; Kee Chee Cheong ; Ng Chee Kai ; Noor Ani Ahmad ; Syafinaz Mohd Sallehuddin ; Tahir Aris
International Journal of Public Health Research 2013;3(2):282-289
Malnutrition can be associated as one of the factors which affect health status. The term is used to describe imbalance of nutrients either over- or under-nourished, resulting in measurable adverse effects on body composition, function and clinical outcome. The National Health And Morbidity Survey (NHMS) 2011 assessed 4304 individuals aged 10-17 years old through a household survey of Malaysian population. Thinness and obesity are the malnutrition indicators based on Centre for Disease Control (CDC) 2000 classification as recommended by WHO (2007). The findings of the survey showed that the national prevalence of thinness (BMI for age <-2SD), was 9.7% (95% Confidence Interval: 8.4-11.2). The state of Sabah/Labuan had the highest thinness of prevalence, 17.0% (11.1-25.2) and lowest in Penang at 5.3% (2.7-10.0). The prevalence of thinness was higher in urban areas than in rural areas at 10.3% (8.5-12.3). Meanwhile; national prevalence of obesity (BMI for age ≥+2SD) was only 5.7% (4.9-6.7). The state of Perak had the highest obesity prevalence 10.0% (6.2-15.8) and lowest in Sabah/Labuan at 2.4% (1.4-4.1). The obesity prevalence was higher among adolescents in urban areas at 6.3% (5.2-7.6) than in rural areas. Thinness as a form of malnutrition is more prevalent than obesity. Even though the prevalence of obesity is low, the impact affects not only the adolescents, but also the family, the society and the nation in the future. The increasing prevalence of obesity will have significant public health implication related to non-communicable diseases.
Obesity
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Thinness
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Adolescent
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Malaysia
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Malnutrition
9.Factors associated with sugar-sweetened beverages consumption among Malaysian adolescents: findings from the Adolescent Nutrition Survey 2017
Ruhaya Salleh ; Ahmad Ali Zainuddin ; Safiah Md Yusof ; Cheong Siew Man ; Mohamad Hasnan Ahmad ; Nur Shahida Abd. Aziz ; Lalitha Palaniveloo ; Azli Baharudin ; Norazizah Ibrahim Wong
Malaysian Journal of Nutrition 2021;27(No.1):177-187
Introduction: Childhood obesity is a public health problem in Malaysia. Intake of
sugar-sweetened beverages (SSB) is associated with obesity in children. There is a
lack of studies on factors associated with SSB consumption in Malaysia. This study
aimed to determine the sociodemographic factors associated with SSB consumption
among Malaysian adolescents. Methods: Data of 2,021 students, aged 10-17
years on sociodemographic, SSB intake and anthropometrics were drawn from
the school-based Adolescent Nutrition Survey 2017. A multistage stratified cluster
sampling was used to obtain a nationally representative sample of primary and
secondary school students. Body mass index (BMI)-for-age status was determined
based on calculated z-score using the World Health Organization 2007 reference.
SSB consumption was obtained from a food frequency questionnaire. Results: The
prevalence of overweight and obesity among Malaysian adolescents were 16.6% and
14.7%, respectively. Malaysian adolescents consumed 1.4 cups of SSB per day.
Rural children had a significantly higher SSB intake (1.5 cups) than urban (1.3
cups) children, while males (1.5 cups) had a significantly higher intake than females
(1.3 cups). There were no significant differences in SSB consumption between thin,
normal, overweight and obese adolescents. Conclusion: Almost all Malaysian
adolescents consumed SSB during one month prior to the survey and the average
amount consumed was 1.4 cups per day. Rural locality and male were associated
with higher SSB consumption. There were differences in SSB consumption
between Chinese and Malays, between Chinese and Indians, and between Chinese
and Bumiputra Sarawak. There were no differences in consumption between the
different BMI-for-age categories.
10.Malaysian Healthy Diet Online Survey (MHDOS): Study rationale and methodology
Jyh Eiin Wong ; Fui Chee Woon ; Yit Siew Chin ; Wai Siew Teh ; Rusidah Selamat ; Ahmad Ali Zainuddin ; Gilly A Hendrie ; E Siong Tee
Malaysian Journal of Nutrition 2023;29(No.2):273-283
Introduction: Access to accurate and timely dietary information is of
paramount importance in evaluating and developing well-targeted public
health nutrition interventions. However, nationwide nutrition surveys are
conducted infrequently because they are very costly to design, conduct
and analyse. Dietary assessment tools, which are quick and cost- effective,
are needed for population research and regular monitoring of Malaysians’
dietary habits. This paper describes the rationale and methodology of the
Malaysian Healthy Diet Online Survey (MHDOS) project, which aims to
bridge this knowledge gap on dietary intake of Malaysian adults. The main
objective of the two-year project is to develop MHDOS as a valid tool to
measure compliance with the Malaysian Dietary Guidelines 2020. Methods:
The MHDOS project has three study phases, namely (i) adaptation of an
online survey and established diet quality scoring system for Malaysia,
(ii) usability, validity and reliability testing of the online survey; and (iii)
online survey administration in a nationwide study. The survey will be
administered to approximately 10,000 Malaysian adults aged 18-59 years.
Discussion: MHDOS consists of 38 questions that measures the quantity,
quality and variety of foods consumed. Individuals will receive a diet quality
score that reflects their overall compliance with the Malaysian Dietary
Guidelines and feedback on how to improve their scores. The findings of
the online survey, which serve to complement information between larger
surveys, will be useful to measure compliance of Malaysians to national
dietary guidelines and inform public health interventions.