Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.

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.

Introduction: Adolescence is an important growth period for individuals. High prevalence of obesity among adolescents in Malaysia in recent years is worrying. This study aims to assess associations of gender and BMI-for-age status (BAZ) with nutrient intake of adolescents between 13-17 years old in Malaysia. Methods: Data of 999 respondents were drawn from Adolescent Nutrition Survey 2017; a cross-sectional school-based survey involving adolescents aged 10 to 17 years old. Respondents were selected using multistage stratified cluster sampling from 13 states and three federal territories in Malaysia to ensure nationally representative data. Data collection was undertaken from March until May 2017. Dietary intake was assessed using a single 24-hours dietary recall conducted via face-to-face interview by trained nutritionists. Nutritionist ProTM Diet Analysis Software was used to calculate nutritional intake values. Anthropometric measurements were measured using validated equipment. Nutritional status of the respondents was assessed using BMI-for-Age z-score and categorised based on WHO Growth Reference 2007. Results: The mean energy intake of the adolescents was 1972 kcal/day. Majority of the adolescents had normal BMI (74.6%) while overweight, obese and thinness were 12.0%, 7.2% and 6.2% respectively. Boys had significantly higher intakes of energy, carbohydrate, protein, fat, sugar, cholesterol, thiamin, Vitamin A, calcium, iron, sodium and potassium compared to the girls. Obese adolescents had significantly higher energy, carbohydrate, fat, sugar, Vitamin A and calcium intakes compared to other BMI groups. Conclusion: The findings highlighted the need for cultivating self-awareness on healthy eating among adolescents.

Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.

Carbonated soft drinks (CSD) consumption is one of the contributing factors to weight gain, dental caries and non-communicable diseases among adolescents. This study aims to determine CSD consumption among Malaysian adolescents and their associated factors. The Adolescent Health Survey 2017, was a nationally representative survey sampled school-going adolescents aged 13 to 17 years. Findings reported that 36.9% of adolescents reported CSD consumption at least once daily in the past 30 days, and the prevalence was higher than a similar study conducted in 2012. Boys, schools in rural areas, lower secondary schoolers, not physically active, consuming fast food, having food insecurity, and truancy problem reported significantly higher odds of consuming CSD compared to their counterparts. By ethnicity, Bumiputera Sarawak adolescents showed the highest odds of consuming CSD and followed by Bumiputera Sabah. Thus, interventions to limit CSD consumption among Malaysian adolescents should consider the factors highlighted in this study.

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 ; Malaysia ; Adult ; Nutrition Survey

Introduction: Changes in dietary habits are known to be associated with changes in health outcomes. This study determined food choices among Malaysian adults using secondary data of the Malaysian Adults Nutrition Survey (MANS) in 2003 and MANS in 2014. Methods: A total of 6,742 and 3,000 adults aged 18 to 59 years participated in MANS 2003 and MANS 2014, respectively. Both studies used a semi-quantitative food frequency questionnaire (FFQ) to assess habitual food intake. Results: Overall, the prevalence of adults consuming rice twice daily were 97.3% and 86.9% in 2003 and 2014, respectively. While the percentage of urban dwellers who consumed rice daily differed significantly between 2003 (96.7%) and 2014 (86.9%), the percentage remained quite similar among rural adults in 2003 (97.8%) and 2014 (96.3%). Other top ten food items consumed daily were sugar (2003, 58.5% vs 2014, 55.9%), marine fish (40.8% vs 29.4%), green leafy vegetables (39.9% vs 43.2%) and sweetened condensed milk (35.2% vs 29.3%). In both surveys, a higher percentage of men consumed rice, sugar and sweetened condensed milk on a daily basis compared to women, a higher proportion of whom daily consumed green leafy vegetables and marine fish. Majority of the adults reported drinking plain water daily. Other beverages taken daily were tea, coffee and chocolate-malt drinks. Conclusion: Rice, sugar and sweetened condensed milk were among the top food items consumed daily in 2003 and 2014. Educational efforts to improve dietary intake of Malaysian adults is recommended.

Limited health literacy is highly associated with poor health status. The concept of health literacy in public health relates to the concern that people with lower health literacy were also less likely to engage in health promoting behaviours. This is an analysis on health literacy and its associated factors among housewives and also a sub analysis of the Malaysian My Body is Fit and Fabulous at Home (MyBFF@home) study involving 328 overweight and obese housewives living in low cost flats in Klang Valley, part of a weight loss programme recruited using convenient sampling. Health literacy was measured using the Malay version of Newest Vital Sign (NVS) test with scores ranging from 0 to 6. Total score of ≤2 indicate limited health literacy and total scores of >2 indicate adequate health literacy. Descriptive analysis, chi-square test and multiple logistic regression were used to analyse the data.The mean(SD) NVS score was 1.07(1.19) with most (87.5%) housewives having limited health literacy. Factors that were significantly associated with limited health literacy were older age of 45 to 59 years old (p = 0.040), primary education and below (p = 0.001) and absence of internet connectivity (p = 0.001). In the final model, absence of internet connectivity (OR 2.61; 95%CI 1.31 to 5.22) was associated with limited health literacy. Majority of the housewives have limited health literacy and providing internet connectivity to housewives may increase their health literacy.
housewives ; health literacy ; low cost flats ; Newest Vital Sign ; obese

​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.