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Fulltext Intake of added sugar in Malaysia: a review

Amarra MS, Khor GL, Chan P

Asia Pac J Clin Nutr, 2016;25(2):227-40.
PMID: 27222405 DOI: 10.6133/apjcn.2016.25.2.13

The term 'added sugars' refers to sugars and syrup added to foods during processing or preparation, and sugars and syrups added at the table. Calls to limit the daily intakes of added sugars and its sources arose from evidence analysed by WHO, the American Heart Association and other organizations. The present review examined the best available evidence regarding levels of added sugar consumption among different age and sex groups in Malaysia and sources of added sugars. Information was extracted from food balance sheets, household expenditure surveys, nutrition surveys and published studies. Varying results emerged, as nationwide information on intake of sugar and foods with added sugar were obtained at different times and used different assessment methods. Data from the 2003 Malaysian Adult Nutrition Survey (MANS) using food frequency questionnaires suggested that on average, Malaysian adults consumed 30 grams of sweetened condensed milk (equivalent to 16 grams sugar) and 21 grams of table sugar per day, which together are below the WHO recommendation of 50 grams sugar for every 2000 kcal/day to reduce risk of chronic disease. Published studies suggested that, for both adults and the elderly, frequently consumed sweetened foods were beverages (tea or coffee) with sweetened condensed milk and added sugar. More accurate data should be obtained by conducting population-wide studies using biomarkers of sugar intake (e.g. 24-hour urinary sucrose and fructose excretion or serum abundance of the stable isotope 13C) to determine intake levels, and multiple 24 hour recalls to identify major food sources of added sugar.
Compliance with WHO IYCF Indicators and Dietary Intake Adequacy in a Sample of Malaysian Infants Aged 6-23 Months

Khor GL, Tan SY, Tan KL, Chan PS, Amarra MS

Nutrients, 2016 Dec 01;8(12).
PMID: 27916932

BACKGROUND: The 2010 World Health Organisation (WHO) Infant and Young Child Feeding (IYCF) indicators are useful for monitoring feeding practices.
METHODS: A total sample of 300 subjects aged 6 to 23 months was recruited from urban suburbs of Kuala Lumpur and Putrajaya. Compliance with each IYCF indicator was computed according to WHO recommendations. Dietary intake based on two-day weighed food records was obtained from a sub-group (N = 119) of the total sample. The mean adequacy ratio (MAR) value was computed as an overall measure of dietary intake adequacy. Contributions of core IYCF indicators to MAR were determined by multinomial logistic regression.
RESULTS: Generally, the subjects showed high compliance for (i) timely introduction of complementary foods at 6 to 8 months (97.9%); (ii) minimum meal frequency among non-breastfed children aged 6 to 23 months (95.2%); (iii) consumption of iron-rich foods at 6 to 23 months (92.3%); and minimum dietary diversity (78.0%). While relatively high proportions achieved the recommended intake levels for protein (87.4%) and iron (71.4%), lower proportions attained the recommendations for calcium (56.3%) and energy (56.3%). The intake of micronutrients was generally poor. The minimum dietary diversity had the greatest contribution to MAR (95% CI: 3.09, 39.87) (p = 0.000) among the core IYCF indicators.
CONCLUSION: Malaysian urban infants and toddlers showed moderate to high compliance with WHO IYCF indicators. The robustness of the analytical approach in this study in quantifying contributions of IYCF indicators to MAR should be further investigated.
Fulltext Adherence of Malaysian Adults' Energy and Macronutrient Intakes to National Recommendations: A Review and Meta-Analysis

Shahar S, Jan Bin Jan Mohamed H, de Los Reyes F, Amarra MS

Nutrients, 2018 Oct 28;10(11).
PMID: 30373303 DOI: 10.3390/nu10111584

The present study examined the best available evidence regarding energy and macronutrient intake during adulthood (age 19 to 59 years) in Malaysia and assessed whether intakes adhere to national recommendations, in order to develop recommendations for dietary improvement based on population consumption patterns. A literature review and meta-analysis evaluated intake based on the following characteristics, using information from food balance sheets, national surveys, and individual studies: (1) levels of intake, (2) proportion of the population whose diets adhere to/exceed/fail to meet Malaysian Recommended Nutrient Intake (RNI) levels, and (3) sources of macronutrients observed in these studies. Food balance data suggested high levels of available energy, animal source protein, vegetable fat, and refined carbohydrates. Twenty studies (five nationwide, 15 individual) indicated that Malaysian adults generally met or exceeded recommendations for fat and protein, but were inconsistent with respect to energy and carbohydrates. Information on dietary sources was limited. Due to methodological limitations, insufficient evidence exists regarding energy and macronutrient intakes of Malaysian adults. Improved dietary assessment methods (including use of biomarkers), better data analysis, and updated food composition data, will provide more reliable information on which to base policy decisions and recommendations for improvement.
Fulltext Salt intakes and salt reduction initiatives in Southeast Asia: a review

Batcagan-Abueg AP, Lee JJ, Chan P, Rebello SA, Amarra MS

Asia Pac J Clin Nutr, 2013;22(4):490-504.
PMID: 24231008 DOI: 10.6133/apjcn.2013.22.4.04

Increased dietary sodium intake is a modifiable risk factor for cardiovascular disease. The monitoring of population sodium intake is a key part of any salt reduction intervention. However, the extent and methods used for as-sessment of sodium intake in Southeast Asia is currently unclear. This paper provides a narrative synthesis of the best available evidence regarding levels of sodium intake in six Southeast Asian countries: Indonesia, Malaysia, Philippines, Singapore, Thailand, Vietnam, and describes salt reduction measures being undertaken in these countries. Electronic databases were screened to identify relevant articles for inclusion up to 29 February 2012. Reference lists of included studies and conference proceedings were also examined. Local experts and researchers in nutrition and public health were consulted. Quality of studies was assessed using a modified version of the Downs and Black Checklist. Twenty-five studies fulfilled the inclusion criteria and were included in this review. Full texts of 19 studies including government reports were retrieved, with most studies being of good quality. In-sufficient evidence exists regarding salt intakes in Southeast Asia. Dietary data suggest that sodium intake in most SEA countries exceeded the WHO recommendation of 2 g/day. Studies are needed that estimate sodium intake using the gold standard 24-hour urinary sodium excretion. The greatest proportion of dietary sodium came from added salt and sauces. Data on children were limited. The six countries had salt reduction initiatives that differed in specificity and extent, with greater emphasis on consumer education.
Fulltext ILSI Southeast Asia symposium: prevalence, risk factors, and actions to address gestational diabetes in selected Southeast Asian countries

Amarra MS, Chong MF, Titapant V, Somprasit C, Rogacion J, Irwinda R, et al.

Eur J Clin Nutr, 2021 Sep;75(9):1303-1308.
PMID: 33531635 DOI: 10.1038/s41430-020-00838-6
Fulltext Sugars and sweeteners: science, innovations, and consumer guidance for Asia

Drewnowski A, Tappy L, Forde CG, McCrickerd K, Tee ES, Chan P, et al.

Asia Pac J Clin Nutr, 2019;28(3):645-663.
PMID: 31464412 DOI: 10.6133/apjcn.201909_28(3).0025

BACKGROUND AND OBJECTIVES: Rising obesity in Southeast Asia, one consequence of economic growth, has been linked to a rising consumption of energy from added sugars. This symposium, organized by ILSI Southeast Asia, explored regional issues related to dietary sugars and health and identified ways in which these issues could be addressed by regional regulatory agencies, food producers, and the consumer.
METHODS AND STUDY DESIGN: Papers on the following topics were presented: 1) current scientific evidence on the effects of sugars and non-caloric sweeteners on body weight, health, and eating behaviors; 2) innovations by food producers to reduce sugar consumption in the region; 3) regional dietary surveillance of sugar consumption and suggestions for consumer guidance. A panel discussion explored effective approaches to promote healthy eating in the region.
RESULTS: Excessive consumption of energy in the form of added sugars can have adverse consequences on diet quality, lipid profiles, and health. There is a need for better surveillance of total and added sugars intakes in selected Southeast Asian countries. Among feasible alternatives to corn sweeteners (high fructose corn syrup) and cane sugar are indigenous sweeteners with low glycemic index (e.g., coconut sap sugar). Their health benefits should be examined and regional sugar consumption tracked in detail. Product reformulation to develop palatable lower calorie alternatives that are accepted by consumers continues to be a challenge for industry and regulatory agencies.
CONCLUSIONS: Public-private collaborations to develop healthy products and effective communication strategies can facilitate consumer acceptance and adoption of healthier foods.