Development and promotion of dietary guidelines is one of the key activities outlined in the National Plan of Action for Nutrition of Malaysia for the prevention of nutrition-related disorders. The first official Malaysian Dietary Guidelines (MDG) was published in 1999 and was thoroughly reviewed and launched on 25 March 2010. The new MDG 2010 is a compilation of science-based nutrition and physical activity recommendations. These guidelines form the basis of consistent and scientifically sound nutrition messages for the public. There are 14 key messages and 55 recommendations, covering the whole range of food and nutrition issues, from importance of consuming a variety of foods to guidance on specific food groups, messages to encourage physical activities, consuming safe food and beverages and making effective use of nutrition information on food labels. The MDG also has an updated food pyramid. Various efforts have been made to ensure that the revised MDG is disseminated to all stakeholders. The Ministry of Health has organised a series of workshops for nutritionists and other health care professionals, and the food industry. In collaboration with other professional bodies and the private sector, the Nutrition Society of Malaysia has been promoting the dissemination and usage of the MDG to the public through a variety of formats and channels. These include the publication of a series of leaflets, educational press articles, educational booklets, as well as through educational activities for children. It is imperative to monitor the usage and evaluation of these dietary messages.
The sustained economic growth and increasing economic stability in the Asian region over the last three decades have been accompanied by changing lifestyles leading to significant changes in the food and nutrition issues facing Asian countries. The chronic diseases associated with excessive consumption of nutrients, especially fat, are becoming increasingly apparent. At the same time, Asia has a disproportionate share of the malnutrition problem. Underweight and stunting remain significant problems in many Asian communities, and micronutrient deficiencies of iron, iodine, and vitamin A continue to afflict large population groups. Effective data collection and analysis are essential to formulate and implement intervention programs to address both sides of the changing nutrition scenario in Asia.
Since the discovery of vitamin A as a fat-soluble growth factor in the early part of the century, research into carotenoids and retinoids has attracted the attention of many scientists. These two groups of compounds are still being actively studied all over the world since many gaps in knowledge exist and new frontiers are being pursued. Recent developments in studies into the possible roles of carotenoids and retinoids beyond their classical functions in vision have created a great deal of excitement in the biomedical community. This review covers a wide range of topics pertaining to these two closely related compounds. Particular emphasis is given to the functions of these compounds and their roles in human nutrition. Various aspects of vitamin A deficiency and studies on carotenoids and retinoids in cancer development and prevention are reviewed in some detail.
A workshop on National Plans of Action for Nutrition: Constraints, Key Elements for Success, and Future Plans was convened and organized by the WHO Regional Office for the Western Pacific in collaboration with the Institute for Medical Research Malaysia and co-sponsored with FAO and UNICEF from 25-29 October 1999. It was attended by representatives of 25 countries in the region and resource persons, representatives from WHO and other international agencies. The objectives of the workshop were to review the progress of countries in developing, implementing and monitoring national plans of action for nutrition (NPANs) in the Western Pacific Region and to identify constraints and key elements of success in these efforts. Most of the countries have NPANs, either approved and implemented or awaiting official endorsement. The Plan formulation is usually multisectotal, involving several government ministries, non-governmental organizations, and international agencies. Often official adoption or endorsement of the Plan comes from the head of state and cabinet or the minister of health, one to six years from the start of its formulation. The NPAN has stimulated support for the development and implementation of nutrition projects and activities, with comparatively greater involvement of and more support from government ministries, UN agencies and non-governmental agencies compared to local communities, bilateral and private sectors and research and academic institutions. Monitoring and evaluation are important components of NPANs. They are, however, not given high priority and often not built into the plan. The role of an intersectoral coordinating body is considered crucial to a country's nutrition program. Most countries have an intersectoral structure or coordinating body to ensure the proper implementation, monitoring and evaluation of their NPANs. The workshop identified the constraints and key elements of success in each of the four stages of the NPAN process: development, operationalization, implementation, and monitoring and evaluation. Constraints to the NPAN process relate to the political and socioeconomic environment, resource scarcity, control and management processes, and factors related to sustainability. The group's review of NPAN identified successful NPANs as those based on recent, adequate and good quality information on the nutritional situation of the country, and on the selection of strategies, priorities and interventions that are relevant to the country and backed up by adequate resources. Continued high level political commitment, a multisectoral approach, and adequate participation of local communities are other key elements for success. The participants agreed on future actions and support needed from various sources for the further development, implementation, monitoring and evaluation of their NPANs. The recommendations for future actions were categorized into actions pertaining to countries with working NPAN, actions for countries without working NPAN and actions relevant to all countries. There was also a set of suggested actions at the regional level, such as holding of regular regional NPAN evaluation meetings, inclusion of NPAN on the agenda of regional fora by the regional organizations, and strengthening of regional nutrition networks.
Over the last three decades, there has been significant changes in the lifestyles of commmunities, including food habits, and food purchasing and consumption patterns in the Southeast Asian region. As a result, there is a definite change in the food and nutrition issues in the region. Nutritional deficiencies in many of these countries are slowly being decreased in magnitude. On the other hand, the significant proportions of the population are now faced with the other facet of the malnutrition problem, namely diet-related chronic diseases. However, because of the different stages of socio-economic development, the extent of each of these extremes of the malnutrition problems varies considerably between the different countries in Southeast Asia. Nutrition needs in the new millennium would necessarily differ somewhat among these countries while at the same time, there would be a considerable amount of similarities. This presentation highlights several macro issues that countries in the region may focus on in the near future. Various intervention programmes have been undertaken by authorities to tackle the co-existence of twin faces of malnutrition in many developing countries. It would be desirable to have a blue print of such programmes and activities in the National Plans of Action for Nutrition (NPANs) . The NPAN should be more than a framework or a descriptive document. It should be a tool for action, an operational plan that sets out priorities; identifies projects and activities, with details of implementation such as what, how and when; designates responsibilities and accountability for the activities; identifies resource requirements and their source; and sets out the plan for monitoring and evaluation. One of the main obstacles in the formulation and effective implementation of intervention programmes in developing countries is the lack of comprehensive data on the extent of the problems in many cases and the causes of such problems specificy to the communities concerned. It is thus imperative to identify appropriate research priorities and conduct relevant studies. It is also important to have basic baseline data collected at regular intervals such as nutritional status of communities and dietary intake. To conduct all these activities, it is vital to ensure adequate funding, preferably through establishing a dedicated fund for research. There should be closer collaboration between countries in the region in all nutrition activities to enable sharing of resources, experiences and learn from the mistakes of others. One existing mechanism is through the ASEAN structure. The other existing mechanisms are through WHO and FAO. One other mechanism is through the International Life Sciences Institute (ILSI) Southeast Asian Branch. Closely related to this need for networking is the need for continuing harmonization of approaches to nutrition activities in the region. Current efforts in harmonisation include RDA, nutritional status assessment methodologies and dietary guidelines. Other areas of harmonisation in the near future include nutrition labelling and claims.
Rapid and marked socioeconomic advancements in Malaysia for the past two decades have brought about significant changes in the lifestyles of communities. These include significant changes in the dietary patterns of Malaysians, eg the increase in consumption of fats and oils and refined carbohydrates and a decreased intake of complex carbohydrates. This resulted in a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat has been observed. Changes in meal patterns are also evident: more families eat out, busy executives skip meals, the younger generation miss breakfasts and rely too much on fast foods. Many Malaysians have the mistaken belief that the taking of vitamin and mineral supplements can make up for the lack of these nutrients in their daily diets. In addition, communities have become generally more sedentary. All these changes have brought about undesirable effects with significant proportions of the affluent segments of the population being afflicted with various non-communicable diseases associated with overnutrition, namely obesity, hypertension, coronary heart disease and cancers. Nutrition activities and programmes are now being directed to tackle this increasing trend, whilst still attempting to eliminate the undernutrition problems. The ultimate strategy towards achieving a healthy nation is the promotion of a healthy lifestyle, including inculcating a culture of healthy eating. Comprehensive long term programmes, including a series of Healthy Lifestyle (HLS) Programmes have been carried out by the government. Launched in 1991 for six consecutive years, the first phase of the Programme comprised one thematic campaign each year, commencing with coronary heart disease and ending with diabetes mellitus. To further strengthen this long-term strategy, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. The implementation of these programmes is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, "western" dietary pattern influence, a whole barrage of convenience and "health" foods and nutrition misinformation. Malaysia continues to march ahead with its development plans to elevate the nation and its people to an even higher level of socio-economic status. The crucial question is: are we able to arrest the increase in these diet-related chronic diseases ? Or are we heading towards further deterioration in dietary pattern and increase in these diseases ? It will be a difficult and challenging journey ahead, requiring the concerted effort of all in the country. It is hoped that through this conference of sharing experiences with other Asian countries, a better understanding and improved strategies could be arrived at.
The determination of serum vitamins having antioxidant properties has gained in importance in recent years. This is mainly due to the observation that an inverse correlation exists between blood levels of these vitamins, including retinol, carotenoids and tocopherol, and diet-related chronic diseases such as coronary heart disease and cancers. This laboratory has been carrying out a series of studies into the nutritional and analytical aspects of retinol and carotenoids. A simple reversed-phase HPLC method has been developed in an effort to improve methodologies for the separation and quantitation of carotenoids and retinol in foods and biological specimens, especially blood serum. As an extension to these studies, trials were carried out to determine the feasibility of analysing tocopherols using the same chromatographic procedure. With the addition of another detector wavelength, the same procedure detected and quantitated 3 major tocopherols simultaneously with retinol and five carotenoids. Within-day and between-day precision of the procedure was satisfactory. Trials carried out were able to improve recovery of the vitamins. Experiments conducted also showed that the addition of ascorbic acid to the extracting ethanol was beneficial for the analytical procedure. The presence of peroxide in ethyl acetate used in the chromatography mobile phase caused drastic destruction to the vitamins analysed. The addition of ascorbic acid during sample preparation was able to inhibit this destruction. The method was used for the analysis of sera from 65 apparently healthy Malaysians with a mean age of 52.8 years (range 24-76 years). Mean retinol concentration of the group was 69.8 ± 18.8 mg/dl. The mean β-carotene concentration of the subjects studied was 33.8 ± 24.3 mg/dl, while the mean total carotenoid concentration was 180.2 ± 3.0 mg/dl. The most abundant carotenoid in the serum samples studied was lutein, comprising about one-third of all carotenoids quantitated. The concentrations of δ- and γ-tocopherols in the serum samples studied were too low to be identified with certainty and quantitated accurately. The mean α-tocopherol level was 1840 ± 528 μg/dl. For retinol, α-tocopherol and most of the carotenoids determined, there was no statistically significant difference in the mean levels between male and female subjects as well as among the three different ethnic groups. Results obtained in this study were very similar to those previously reported by this laboratory. It is hoped that more data on the serum concentrations of these vitamins can become available for various population groups, including during various disease conditions.
This paper presents the results of anthropometric assessment of 2,364 boys and 2,415 girls aged 18 years and below drawn from the estates and rural community groups engaged in padi farming, rubber planting, coconut cultivation and fishing. The children were mainly Malay, however in the estates, Indians predominated. The results showed that the percentage of boys who have normal weight-for-age, height-for-age and weight-for-height were respectively 69.4%, 68.3% and 88.8%. Among girls, the percentage with normal values for weight-for-age, height-for-age and weight-for-height were 73.8%, 72.6% and 89.5% respectively. This study also showed the persistence of underweight, stunting and wasting amongst children in the study communities. Overall, the prevalence of underweight among boys was 29.8% and for girls 25.5%. The prevalence of stunting was 31.3% for boys and 26.9% for girls, while wasting was found in 9.3% boys and 8.5% girls. By age groups, the prevalence of underweight was lowest among the infants (16.8% for boys and 13.3% for girls), and highest among children aged above 1 to 6 years old (32.6% and 35.9% for boys and girls respectively). Children from the fishing, rubber and padi villages showed a higher prevalence of acute and chronic undernutrition than those from the coconut and the estate communities. In contrast, the mean prevalence of overweight in the five community groups did not exceed 2%. When compared with another peninsula-wide nutritional assessment of poverty villages undertaken in 1979-1983, it is found, over the past decade, that the prevalence of underweight in rural communities appeared to have decreased somewhat while that of stunting showed a more substantial decline. The persistence of current undernutrition has led to the manifestation of children who were too thin for their "non-stunted" height, thus giving rise to an apparently higher prevalence of wasting as found in this study. The implications of these results are discussed.
There are significant differences in the food consumption patterns of countries. In the lower income countries, most of the energy intake is derived from cereals and starchy roots. On the other hand, the intake of these carbohydrate foods is much lower in the economically developed countries and more of the energy is derived from added fats, alcohol, meat, dairy products and sweeteners. The contribution of energy from various food groups has changed markedly over the past three decades. With increasing national wealth there is a general tendency for the consumption of cereal foods to decline, whereas the consumption of added fats, alcohol, meat and dairy products has increased over the years. Similar changes have also been observed for Malaysia. These dietary alterations, as well as other lifestyle changes, have brought about a new nutrition scenario in many developing countries. These countries are now faced with the twin problems of malnutrition, that is, undernutrition among some segments of the population and diet-related chronic diseases in other groups; for example, obesity, hypertension, coronary heart disease, diabetes and various cancers. In Malaysia, deaths due to diseases of the circulatory system and neoplasms have been on the rise since the 1960s. The former has been the most important cause of death in the country for more than 15 years, with cancer ranking third for almost 10 years. Epidemiological data collected from different community groups showed increased prevalences of various risk factors amongst Malaysians. In view of the changed nutrition scenario in the country, intervention programmes have been reviewed accordingly. The Healthy Lifestyle (HLS) Programme was launched in 1991 as a comprehensive, long-term approach to combating the emerging diet-related chronic diseases. For six consecutive years one thematic campaign per year was carried out; namely, coronary heart disease (1991), sexually transmitted diseases (1992), food safety (1993), childhood diseases (1994), cancers (1995) and diabetes mellitus (1996). To further strengthen health promotion among the community, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. In view of the importance of diet and nutrition in the causation and prevention of chronic diseases, the theme for the first year of this phase was Healthy Eating. It is clear that nutrition education for the community in order to inculcate a culture of healthy eating is the long-term solution. A series of guidelines have been prepared for dissemination to the public via a variety of media and approaches, and with the collaboration of various government and non-governmental organisations. The implementation of the programme is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, 'western' dietary pattern influence, a whole barrage of convenience and 'health' foods, and nutrition misinformation. We would like to share our experiences in the approaches taken and our concerns with other countries in the region given that various opportunities exist for collaboration.
A nutritional study was carried out on six (five rural and one urban) low income groups in Peninsular Malaysia from 1992-1995. In this paper, the socio-economic data for the five rural groups - padi farmers, rubber smallholders, coconut smallholders, estate workers, and fishermen - are presented. With the exception of the estate workers, the sample was predominantly Malay, with an overall mean household size of 5.30. Household incomes were generally low, and 47% of all households had incomes that were below the poverty line income (PLI) of RM405. Based on this PLI, the prevalence of poverty was above 50% among the padi, rubber, coconut, and fishing households. Nevertheless, the study population appeared to be better off in terms of the other indicators examined. Poultry rearing, for example, was widespread in the padi, rubber, and coconut villages; 65% of all households owned at least one motorised vehicle, 53% owned a refrigerator, and 83% owned a television set. Furthermore, over 80% of all households had access to piped water, 96% had electricity supply, and over 90% had a flush or pour-flush latrine. In comparison to the 1979-1983 poverty villages study (Chong et al., 1984), the households in the current study enjoyed better living conditions. Strict comparisons between the two studies, however, is difficult owing to the different criteria adopted in the selection of the study villages.
The theoretical impact of the use of coconut cream (santan) powder and palm oil santan powder on the dietary levels of C12-16 saturated fatty acids (SFAs) and linoleic acid (18:2), and on serum total cholesterol (TC), was evaluated holding non-santan dietary variables constant. The prediction was based on a 2,300-kcal hypothetical diet, containing one santan-based dish or snack in each of the 5 daily meals with fat contributing 30% of total calories, while the santan contributed a total of 14% kcal (36g). Replacing coconut santan with palm oil santan reduced the overall dietary C12-16 SFAs from 10.8% kcal to 4.8% kcal (i.e. 6.0% kcal) and the virtual removal of lauric (12:0) + myristic (14:0) acids, while palmitic acid (16:0) rose by 3.3% kcal, and the polyunsaturated linoleic acid (18:2) increased by 1.13% kcal. Applying the Hegsted equation to these dietary fatty acid (FA) changes, predicted a serum TC reduction of 24 -31 mg/dL (0.62- 0.80 mM/L), with the hypocholesterolemic effect being influenced by the low-density lipoprotein receptor (LDLr) set-point of the individual(s) concerned. Thus, the prediction indicated that replacing coconut santan with palm oil santan in santan-based Malaysian dishes or snacks would have a significant beneficial impact on serum TC and hence, cardiovascular risk.
This review discussed the prevalence of diabetes mellitus (DM) in Malaysia and the associated major risk factors, namely overweight/obesity, dietary practices and physical activity in both adults and school children. Detailed analyses of such information will provide crucial information for the formulation and implementation of programmes for the control and prevention of T2DM in the country. National studies from 1996-2015, and other recent nation-wide studies were referred to. The current prevalence of DM in 2015 is 17.5%, over double since 1996. Females, older age group, Indians, and urban residents had the highest risk of DM. The combined prevalence of overweight/obesity in 2015 is 47.7% for adults. Adults did not achieve the recommended intakes for majority of the foods groups in the Malaysian Food Pyramid especially fruits and vegetables. Adults also had moderate physical activity level. Three nation-wide studies showed a prevalence ranging from 27 to 31% for combined overweight/obesity in school children. The prevalence was higher among boys, primary school age, Indian ethnicity, and even rural children are not spared. Physical activity level was also low among school children. There must be serious systematic implementation of action plans to combat the high prevalence of diabetes and associated risk factors.
The 3-day seminar-workshop on 'Food-based Dietary Guidelines and Nutrition Education' was held from 22-24 July 1998 in Kuala Lumpur, Malaysia to present the latest scientific information on nutrition and health and to discuss its impact on the rationale and process for the development of food-based dietary guidelines (FBDG). The first two sessions were devoted to a review of the current information on the relation between lifestyle factors and chronic diseases, particularly obesity; the present health status and food consumption patterns in Malaysia; the current consensus on carbohydrates and fats and oils and the importance of considering the glycemic index of foods; and the importance of micronutrients in health and disease. The third and fourth sessions dealt with the rationale of FBDG and the process of their development, drawing from the 1990 FAO/WHO Consultation on Development of FBDG and the experience in the Philippines and in Europe. The importance of effective dissemination of nutrition messages to the public was thoroughhly discussed. The workshop sessions arrived at recommendations on important issues in the development of FBDG in the region, including main research and information needs, the steps in the development of FBDG, and strategies for their dissemination.
This paper highlights the marked presence of nutritional disorders in a sample (190 males, 237 females, aged 18-80 years) obtained from the adult population in three kampungs i.e. Pasang Api, Sungai Nipah Baroh and Sungai Balai Darat, in the Mukim of Bagan Datoh, Perak in 1992. All subjects (except pregnant females) were measured for blood pressure, weight, height, waist circumference, and hip circumference from which the body mass index (BMI) and waist-hip ratios (WHR) were calculated. A random blood sample was obtained by finger-prick from each subject and analysed for total cholesterol (TC) and glucose, using the Reflotron compact analyser. Elevated means for BMI and WHR indicated that obesity (BMI ≥30.0) was a serious public health problem in these three kampungs, affecting about 5% of males and 14% of females. Another 24% of males and 46% of females had an overweight problem (BMI 25.0-29.9), indicating that on the average, about half the adult population in these kampungs were either overweight or obese. This contrasted with the situation a decade ago in similar-type kampungs in the Peninsula where underweight was the major nutritional disorder in adults, especially males. Overall, there was a shift of an underweight problem to one of overweight, as exemplified by increments of 2.0 to 3.0 BMI units in the adult population, with the phenomenon being more marked in the females. Hypertension (21%) and hyperglycaemia (6.5%) affected the males and females approximately equally. Female adults had higher mean plasma TC compared to males (204 versus 199 mg/dl); these means were some 20 mg/dl (0.52 mmol/L) higher than the corresponding means for adults in similar rural communitites in the early eighties, and approximate the corresponding means for present-day urban adults. The above findings serve to emphasise the nutritional transition undergoing in the rural communities in the Peninsula, viz, the marked emergence in these rural communities of nutritional disorders normally associated with affluent populations.
The study was conducted to assess the level of understanding and the ability to extract information from a nutrition information panel (NIP) among women (n = 232, 20-59 years) in the Klang Valley, an urban area in Malaysia. The study involved the currently used format in Malaysia and three other formats, namely (i) based on Guideline Daily Amount (GDA), (ii) Multiple Traffic Light (MTL) and (iii) combination of GDA/MTL. Four hypermarkets were chosen for the face-to-face interview using a questionnaire. Subjects were selected using a convenient sampling method. The mean score for level of understanding was the highest for the current format (3.46 ± 1.12) compared to the other three tested formats (GDA = 3.09 ± 1.03, MTL = 2.72 ± 0.97, GDA/MTL combination 3.09 ± 1.36). However, most of the respondents (68.1%) would prefer the current NIP format to be changed due to difficulty in understanding (43.1%) and perceived the nutrition information to be insufficient (23.3%) and over simplified (21.6%). When other NIP formats were introduced, GDA format was the most preferred (mean score 3.52 ± 0.84) compared to the other formats (MTL = 3.41 ± 0.98; GDA/ MTL combination = 3.29 ± 0.91), including the current format used in Malaysia (3.16 ± 0.85). These findings suggest that the preferred NIP format does not necessarily lead to correct interpretation of the nutrition information. The current format should be further promoted and explained to the public to improve its usage and consumer understanding.
Pure olive oil triglycerides (POLO), free from all unsaponifiable matter, were isolated from Virgin Spanish olive oil (COLO) by alumina-charcoal column chromatography. COLO and POLO were used as sources of dietary fat in two animal studies. The responses of serum and liver lipids to the two types of dietary fat were examined. Our results show that animals fed POLO-diet gave somewhat higher serum total and LDL cholesterol levels as compared to those on COLO-diet. The increase in serum cholesterol level is followed by a parallel increase in liver cholesterol content. These results indicate that the hypocholesterolemic effect of olive oil was partly due to the presence of the unsaponifiable matter. Supplement of the POLO-diet separately with a-tocopherol and squalene resulted in serum lipid responses similar to that observed with the COLO-diet. The serum and liver triglyceride levels are not affected by the removal of unsaponifiable components but addition of a--T and squalene to the POLO-diet appeared to lower both the cholesterol and triglyceride levels in the serum but increased only the liver cholesterol content. These results show that the unsaponifiable components modulate the hypocholesterolemic effect of olive oil.