Health, including nuirition is not independent but is closely associated with the social and economic environment. Malnutrition itself can cause death, but more commonly, it can cause considerable ill-health, physical retardation, impaired mental performance, loss in productivity and a decline in the quality of life. The effects of malnutrition as obstacles to socio-economic development are now well recognised. In a rapidly developing country like Malaysia, the nutritional and nutritionally-related problems present themselves with contrasting features. While population indicators such as toddler mortality, incidence of low birthweight and food balance sheet studies suggest an improving nutritional situation, methods of direct assessment have shown that chronic protein-energy malnutrition and anaemia are sWI common amongst pre-school children in both the rural and urban disadvantaged sectors. Moderate anaemia also affects a significant proportion of older children and women of childbearing age. Intestinal parasites, another indicator of under development at the local level, are ubiquitous in the rural setting and urban slums owing to unsatisfactory waste disposal. In striking contrast, diseases associated with dietary excesses and increasing affluence have now emerged as the major killers. This changing pattern of mortality and morbidity along the lines encountered by the industrialised societies is now dramatised by the fact that road accidents are now claiming a large number of victims. It is clear that while continued efforts should be given to the improvement of the nutritional health of both rural and urban poverty communities, little time should be wasted in considering the adoption of public health measures aimed at stemming the rising number of deaths associated with our increasing affluence, particularly those diseases that are nutritionally linked, such as coronary heart disease, hypertension and diabetes mellitus, not forgetting the increasing road toll afflicted by the motor vehicle.
An anthropometric assessment was conducted on a sample of 309 children, aged twelve years and below, from an urban squatter community in Kuala Lumpur, Malaysia. The community consists mainly of Malays and Indians and is fairly established with a mean length of residence of about fifteen years. There was not much difference between the two ethnic groups with regard to educational status or income. Most of the residents were unskilled or semiskilled workers employed in factories and government agencies. About 40 percent of the infants and toddlers were found to be wasted, while about one-third of the older children were stunted. There appears to be some association between income per capita and nutritional status.
Anthropometric and parasitological data from cross-sectional studies of two groups of primary school children (Group I of Indian origin, 325 boys and 259 girls, age = 7 years; Group II of Malay origin, 284 boys and 335 girls, age = 7-9 years) from two different ecological settings in Peninsular Malaysia were examined for epidemiological evidence of an association between hookworm infection and protein-energy malnutrition. In both ecological groups, significant weight, height and haemoglobin deficits were observed in children with hookworm infection after adjustment for covariables including Ascaris and Trichuris infection intensities and other child and family characteristics. The deficits were related to the intensity of infection based on egg counts. These findings suggest that hookworm may be an important determinant of chronic protein-energy malnutrition, as well as anaemia, in areas where diets are generally inadequate in protein, energy, and iron. Well-controlled intervention studies are needed to confirm these observations.
Kuala Lumpur is the capital city of Malaysia with an estimated population of 1.55 million. Approximately 12% of the population live in squatter settlements occupying about 7% of the city total area. The squatter settlements generally are provided with basic amenities such as piped water, toilet facilities and electricity. Health indicators for the overall population of Kuala Lumpur are better off than for the rest of the country; however, intra-city differentials prevail along ethnic and socio-economic lines. Malays and Indians have higher rates for stillbirths, and neonatal, infant and toddler mortality than the Chinese. The wide disparity in the socio-economic status between the advantaged and the poor groups in the city is reflected in the dietary practices and nutritional status of young children from these communities. The percentage of preschool children from urban poor households with inadequate intakes of calories and nutrients is two to three times higher than those from the advantaged group. Compared to rural infants, a lower percentage of urban infants are breastfed. A lower percentage of Malays from the urban advantaged group breastfed, compared with the urban poor group. The reversed trend is found for the Chinese community. Growth attainment of young children from the urban poor is worse than the urban advantaged, though better than the rural poor. Health and nutritional practices implications related to both undernutrition and overnutrition are discussed, to illustrate the twin challenges of malnutrition in the city.
A study to determine the prevalence of goitre and abnormal thyroid status during pregnancy in Malaysian women was conducted. Two hundred and three women (Malay = 85, Chinese = 47 and Indian = 71) in the third trimester and with no known thyroid disease were studied. There was a marked racial disparity in the prevalence of goitre: Indian 61%, Malay 28% and Chinese 29% (p = 0.001). The serum thyrotropic hormone (TSH) was significantly higher in Indians (median: 1.36 uIU/ml) compared to Malays (1.14 uIU/ml, p = 0.009). The serum albumin was also significantly lower in Indians (mean +/- sd; 36.12 +/- 3.9 mmol/l) compared to Malays (39.3 +/- 4.8 mmol/l) or Chinese (39.1 +/- 5.2) (p < 0.001). Thyroid antibody was detected in 14.6% of these women with no significant racial difference in its prevalence. Three women were found to be thyrotoxic but none were hypothyroid. This study found a high prevalence of goitre among the pregnant Indian women, probably related to the protein malnutrition state. The high prevalence of positive thyroid antibody in our population indicates that a high percentage of women are at risk of developing postpartum thyroiditis.
Approximately 70.0% of the world's malnourished children live in Asia, resulting in the region having the highest concentration of childhood malnutrition. About half of the preschool children are malnourished ranging from 16.0% in the People's Republic of China to 64.0% in Bangladesh. Prevalence of stunting and underweight are high especially in South Asia where one in every two preschool children is stunted. Besides protein-energy malnutrition, Asian children also suffer from micronutrient deficiency. Iron deficiency anaemia affects 40.0-50.0% of preschool and primary school children. Nearly half of all vitamin A deficiency and xeropthalmia in the world occurs in South and Southeast Asia, with large numbers of cases in India (35.3 million), Indonesia (12.6 million) and China (11.4 million). Another major micronutrient problem in the region is iodine deficiency disorders, which result in high goiter rates as manifested in India, Pakistan and parts of Indonesia. While under-nutrition problem persists, overweight problem in children has emerged in Asia, including Taiwan, Singapore and urban China and Malaysia. The etiology of childhood malnutrition is complex involving interactions of multiple determinants that include biological, cultural and socio-economic influences. Protein-energy malnutrition and micronutrient deficiency leading to early growth failure often can be traced to poor maternal nutritional and health care before and during pregnancy, resulting in intrauterine growth retardation and children born with low birth weight. While significant progress has been achieved over the past 30 years in reducing the proportion of malnourished children in developing countries, nonetheless, malnutrition persists affecting large numbers of children. The socio-economic cost of the malnutrition burden to the individual, family and country is high resulting in lower cognitive outcomes in children and lower adult productivity. Interventions that are cost-effective and culturally appropriate for the elimination of childhood malnutrition deserve the support of all.
This report is a part of a multi-centre study in Asia on the problem of dual forms of malnutrition in the same households. In Malaysia, the prevalence of underweight and stunting persist among young children from poor rural areas. Overweight in adults, especially women from poor rural areas has been reported in recent years. Thus, this study was undertaken in order to assess the presence of the dual burden of underweight child-overweight mother pairs in a poor rural community. Out of 140 Malay households identified to have at least one child aged 1-6 years and mother aged above 20 years, 52.1% of the mothers were overweight, 15.7% of the children were underweight, 27.1% stunted and 5% wasted. Socio-economic background and food intake frequency data were collected from 54 underweight child/overweight mother pairs (UW/OW) and 41 normal weight child/normal weight mother pairs (NW/NW). Compared with the overweight mothers, a higher percentage of the normal weight mothers had received secondary education, were employed and with a higher household monthly income, although these differences were not significant. Patterns of food intake of the mothers and children appeared to have more similarities than differences between the UW/OW and NW/NW groups. Quantitative dietary intakes for 2 days using 24-hr recall and physical activity energy expenditure over the same period were assessed in a sub-group of UW/OW and NW/NW mothers and children. The NW/NW children showed significantly higher intake of total calories, fat and riboflavin than the UW/OW counterparts. Mean energy and nutrient intake of mothers from both groups were not significantly different, although the NW/NW mothers showed higher intake adequacy for total calories and most nutrients. While most of the mothers from both groups reported having no chronic illnesses, about half of the children in both groups had infections, especially gastrointestinal infections, over a 2-week period. Energy expenditure from physical activity for both UW/OW and NW/NW mothers and children did not differ significantly. This study confirmed inadequate intake of total energy and nutrients as the major factor for underweight in Malay children from rural areas. However, assessing intake and physical activity by interview methods were not sensitive enough to overcome perceived problems of under-reporting of energy intake and over-estimation of energy expenditure, especially by overweight subjects. Further investigations on a larger sample are necessary to understand the family dynamics leading to the double burden of malnutrition within the same household.
A cross-sectional study to examine the association of giardiasis with protein-energy malnutrition, vitamin A deficiency and iron deficiency anaemia was conducted among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2-15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and faecal samples. The results showed that 24.9% of the children were infected with Giardia duodenalis, while 56.5, 61.3 and 15.1% had significant underweight, stunting and wasting, respectively. Giardiasis was statistically identified as a strong predictor of significant wasting in this study population.
This study aims to determine the prevalence of protein-energy malnutrition and its association with soil-transmitted helminthiases in Orang Asli (Aborigine) children in Selangor, Malaysia. The results obtained from 368 children aged 2-15 years showed that the overall prevalence of mild and significant underweight was 32.1% and 56.5% respectively. The prevalence of mild stunting was 25.6% while another 61.3% had significant stunting. The overall prevalence of mild and significant wasting was 39.0% and 19.5% respectively. The overall prevalence of ascariasis, trichuriasis and hookworm infection were 61.9%, 98.2% and 37.0% respectively and of these 18.9%, 23.5% and 2.5% of the children had severe infection of the respective helminthes. The overall prevalence of giardiasis was 24.9%. The present study vividly shows that stunting and underweight are highly prevalent among Orang Asli children and therefore of concern in this community. In this population intestinal parasitic infections, especially severe trichuriasis and giardiasis, were identified as the main predictors of stunting and wasting respectively, in addition to age between 2 to 6 years.
We conducted a cross sectional study to examine the association of intestinal parasitic infections and protein energy malnutrition (PEM) with iron-status indicators and anaemia among Orang Asli children in Selangor, Malaysia. A total of 281 children aged 2 - 15 years were studied. The data were collected using structured questionnaires, anthropometric measurements and laboratory analysis for blood and faecal samples. All children were infected either by A. lumbricoides, T. trichiura or hookworm and almost 19%, 26% and 3% of the children had severe infection of ascariasis, trichuriasis and hookworm infection respectively. The prevalence of giardiasis among them was 24.9%. Overall, 41.5% of the children were anaemic (haemoglobin < 11.0 g/dL). Of these 61.0% of the children had iron deficiency and 36.5% had iron deficiency anaemia (IDA), which accounted for 88.0% of anaemia in this population. Severe trichuriasis had the most significant correlation with anaemia and iron deficiency in this population. It contributed to low concentrations of haemoglobin, serum iron and serum ferritin and high total iron binding capacity (TIBC). Significant underweight and stunting were associated with low concentrations of haemoglobin and serum iron while significant wasting was significantly associated with low concentration of serum ferritin. Logistic regression analysis confirmed that severe trichuriasis was a strong predictor of IDA. It also confirmed that children who were significantly underweight and whose mother was working were independent predictors of IDA in this population.
A multidimensional assessment of nutritional and health status comprised of subjective global assessment (SGA), anthropometry function, biochemistry, dietary intake, social and health aspects was carried out on 820 older people (52.8% men and 47.2% women) from four rural areas of Peninsular Malaysia. A proportion of the subjects had been classified as either overweight (25.7%) or chronic energy deficient (20.3%). Although 49% of subjects had normal body weight, 68.4% have been classified as having mild to moderate malnutrition according to the SGA. Only 1.1% and 2.3% had low serum albumin and ferritin, respectively. Almost 80% of subjects, especially men, were at high risk of cardiovascular diseases on the basis of the assessment of total cholesterol and LDL-cholesterol. The majority of the subjects (87.2%) were fully independent in performing daily tasks, with men having a significantly higher score compared to women (p<0.001). However, men were less likely to be able to perform a flexibility test (50.7%) than were women (27.0%) (p<0.05). The mean energy intake for men (1412 +/- 461 kcal/d) and women (1201 +/- 392 kcal/d) were below the Recommended Nutrient Intake (RNI) for Malaysia, although this is a difficult assertion to make in an age-group which generally experiences declining energy expenditure. Moreover, 52.5% of men and 47.5% of women might have underreported their food intake. Dietary micronutrients most likely to be deficient were thiamin, riboflavin and calcium. It is concluded that a substantial proportion of rural elderly Malays had problems related to both undernutrition and overnutrition. An appropriate nutrition intervention program is needed to improve the nutritional status of rural elderly Malays.
A cross-sectional study was carried out to determine the current prevalence of protein-energy malnutrition (PEM) among Orang Asli schoolchildren and to investigate the potential predictors of malnutrition. A total of 241 (120 males and 121 females) Orang Asli schoolchildren age 7-12 years living in remote areas of Pos Betau, Pahang participated voluntarily in this study. Anthropometric and socioeconomic data were collected and the children were screened for intestinal parasitic infections. The overall prevalences of mild and significant underweight conditions were 52.3% and 37.3%, respectively, and the prevalences of mild stunting and wasting were 43.6% and 43.1%, respectively, while the prevalences of significant stunting and wasting were 43.6% and 5.6%, respectively. There was a significant association between gender (male) and malnutrition (p = 0.029). The results also showed a higher prevalence of stunting among children age < or = 10 years than in older children (p = 0.001). Other independent variables, including socioeconomic status and intestinal parasitic infections, had no significant associations with malnutrition indices. PEM is prevalent among schoolchildren in rural Malaysia and therefore of public health concern since PEM diminishes immune function and impairs cognitive function and educational performance. School-based programs of prevention through health education and interventions should be considered as an essential part of measures to improve the quality of life of schoolchildren in rural Malaysia.
Estimates of FAO indicate that 14% of the population worldwide or 864 million in 2002-2004 were undernourished in not having enough food to meet basic daily energy needs. Asia has the highest number of undernourished people, with 163 million in East Asia and 300 million in South Asia. Meanwhile obesity and diet-related non-communicable diseases continue to escalate in the region. The double burden of malnutrition also affects the poor, which is a serious problem in Asia, as it has the largest number of poor subsisting on less than $1/day. As poverty in the region is predominantly rural, agriculture-based strategies are important for improving household food security and nutritional status. These measures include shifting toward production of high-value products for boosting income, enhancing agricultural biodiversity, increasing consumption of indigenous food plants and biofortified crops. Urban poor faces additional nutritional problems being more sensitive to rising costs of living, lack of space for home and school gardening, and trade-offs between convenience and affordability versus poor diet quality and risk of contamination. Time constraints faced by working couples in food preparation and child care are also important considerations. Combating the double burden among the poor requires a comprehensive approach including adequate public health services, and access to education and employment skills, besides nutrition interventions.
There is limited data on the nutritional status of Asian patients with various aetiologies of cirrhosis. This study aimed to determine the prevalence of malnutrition and to compare nutritional differences between various aetiologies.
Many studies had shown that poor growth in children is associated with malnutrition. The underlying factors are diverse, multisectoral and interrelated, ranging from biological to social, cultural and economically related. Because the highest levels of under-nutrition worldwide are found in South Asia, it is essential that policymakers in the region understand the underlying determinants, in order to design effective public health intervention programs. This is especially so if public resources are limited. The purpose of this cross-sectional study was to examine causal relationships among the biological, behavioural and environmental factors related to malnutrition in children aged 5 years and under.
A nationwide cross-sectional school-based survey was undertaken among children aged 8-10 years old to determine the current iodine deficiency status in the country. Determination of urinary iodine (UI) and palpation of the thyroid gland were carried out among 18,012 and 18,078 children respectively while iodine test of the salt samples was done using Rapid Test Kits and the iodometric method. The results showed that based on WHO/ ICCIDD/UNICEF criteria, the national median UI was 109 μg/L [25th, 75th percentile (67, 166)] showing borderline adequacy. The overall national prevalence of iodine deficiency disorders (IDD) with UI<100 μg/L was 48.2% (95% CI: 46.0, 50.4), higher among children residing in rural areas than in urban areas. The highest prevalence of UI<100 μg/L was noted among the aborigines [(81.4% (95% CI: 75.1, 86.4)]. The national total goitre rate (grade 1 and grade 2 goitre) was 2.1%. Of 17,888 salt samples brought by the school children, 28.2% (95% CI: 26.4, 30.2) were found to have iodine content. However, the overall proportion of the households in Malaysia using adequately iodised salt as recommended by Malaysian Food Act 1983 of 20-30 ppm was only 6.8% (95% CI: 5.1, 9.0). In conclusion, although a goitre endemic was not present in Malaysia, almost half of the states in Peninsular Malaysia still have large proportion of UI level <100 μg/L and warrant immediate action. The findings of this survey suggest that there is a need for review on the current approach of the national IDD prevention and control programme.