“Key Findings of the Recent Malaysian Adult Nutrition Survey

(MANS) 2014”

1

Presenter : Mohamad Hasnan Bin Ahmad

Nutritionist Institute For Public Health

Ministry of Health 50590 Jalan Bangsar, Kuala Lumpur

• 1st Malaysian Adult Nutrition Survey (MANS) was carried out in 2003.

• It was conducted as a nationwide survey, covering Peninsular Malaysia, Sabah & Sarawak.

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Introduction

• The report was published in 8 volumes

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Introduction

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• 2nd MANS was proposed as dietary patterns of Malaysian population may differ from MANS 2003 due to the urbanization and nutrition transition in the recent years.

• Furthermore, current information on dietary intake is

urgently needed to update food and nutrition policies.

• In 2014, Institute for Public Health conducted the second MANS using the National Health and Morbidity Survey (NHMS) platform.

Introduction

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General objectives

To determine the socio-demography in relation to food security status, meal pattern, food intake by food group, food label

reading & understanding, dietary supplement intake, physical activity status, food consumption pattern, nutritional status and nutrient intake of Malaysian adults age 18-59 years old.

Objectives

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Specific objectives

1. To determine food security status of Malaysian. 2. To determine meal pattern of the Malaysian adults. 3. To determine food intake by food group of the Malaysian

adults. 4. To determine food label reading and understanding of

Malaysian adults. 5. To determine dietary supplement intake of Malaysian adult 6. To assess physical activity status of Malaysian adults. 7. To determine food consumption pattern of Malaysian adult 8. To determine nutritional status of Malaysian adults. 9. To determine nutrient intake of Malaysian adults.

Objectives

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• MANS was a nationwide cross-sectional study conducted in March until June 2014.

• Multistage stratified sampling design was used to select

4,044 representative sample of Malaysian adult population, aged 18 to 59 years old.

• Nutritionists and trained research assistants were recruited for data collection.

Methodology

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Modules in Questionnaire • Socio-demography • Food security • Meal pattern • Food intake by food group • Food labeling • Dietary supplements • Physical activity • Food frequency questionnaire (FFQ) • Anthropometry • 24-hour diet recall

All questionnaires went to several QC stages before ready for data analysis.

Methodology

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Key Findings MANS 2014

Out of 4,044 sampled household, 3,574 completed the household questionnaire

(household response rate was 88.4%)

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Key Findings MANS 2014 Food Security

Figure 1. National status of food insecurity based on individual parameters.

24.8

20.8

23.7

15.1

21.9

25.5

24.9

0 5 10 15 20 25 30

Malaysian households were at risk for food insecurity byexploratory factor analysis

6. Could not afford to feed the children with variousfoods.

5. Only rely on cheap and affordable foods to feedchildren.

4. Adult family members had SKIPPED the main meals.

3. Adult family members had REDUCED the size of meals.

2. Ever experience food variety insufficiency.

1. Ever experience food quantity insufficiency.

Prevalence (%)

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Key Findings MANS 2014 Meal Pattern

Figure 2. Prevalence of Meal consumption pattern of Malaysian adults.

93.7 94.5 96.4

31.9

0

20

40

60

80

100

120

Breakfast(7.00am - 10.30am)

Lunch(12.00noon - 2.30pm)

Dinner(6.00pm - 9.00pm)

Heavy meal after dinner

Pre

vale

nce

(%

)

Meals

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Key Findings MANS 2014 Meal Pattern

Figure 3. Comparison prevalence of meal consumption pattern of between

MANS 2003 & MANS 2014

89.2

93.7

88.6

94.5

92.0

96.4

84.0

86.0

88.0

90.0

92.0

94.0

96.0

98.0

MANS 2003 MANS 2014

Pre

vale

nce

(%

) Breakfast(7.00am - 10.30am)

Lunch(12.00noon - 2.30pm)

Dinner(6.00pm - 9.00pm)

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Key Findings MANS 2014 Food Intake By Food Group

Figure 4. Mean serving intake in a day according to food group among

Malaysian adults.

4.4

2.0

2.5

1.7

2.1

0.3 0.4

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Cereal andcereal product

Vegetables Fruits Meat , poultryand egg

Fish and fishproduct

Legumes andlegumeproduct

Milk and Milkproduct

Mea

l ser

vin

g/d

ay

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Key Findings MANS 2014 Food Label

Figure 5. Prevalence of food label reading among Malaysian adults.

23

22

55

Never read

Always Read

Sometimes read

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Key Findings MANS 2014 Dietary Supplement

Figure 6. Prevalence of vitamin & mineral supplement (VMS) and food supplement

(FS) among Malaysian adults.

28.1

34.1

15.6

0

5

10

15

20

25

30

35

40

Vitamin & mineralsupplement (VMS)

Food supplement (FS) VMS & FS

Pre

vale

nce

(%

)

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Key Findings MANS 2014 Dietary Supplement

Figure 7. Comparison prevalence of vitamin & mineral supplement (VMS) and food

supplement (FS) intake between MANS 2003 and MANS 2014.

23.9

28.1 24.8

34.0

0

5

10

15

20

25

30

35

40

MANS 2003 MANS 2014

Pre

vale

nce

(%

)

Vitamin and MineralSupplement

Food Supplement

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Key Findings MANS 2014 Physical Activity

Figure 8. Prevalence of physical activity status of Malaysian adults.

63.1

36.9 Physically Inactive

Physically Active

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Key Findings MANS 2014 Food Consumption Pattern

Figure 9. Prevalence of the top ten foods consumed daily among Malaysian adults population.

89.8

55.9

43.2

29.4

24.2 23.5 20.3 14.6 14.2 12.9

0

10

20

30

40

50

60

70

80

90

100

White rice Sugar Leafy greenvege.

Marine fish Chilies Condensedmilk

Soy sauce Condiment Hen egg Creamcreakers

Pre

vale

nce

(%

)

Food item

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MANS 2003 MANS 2014

Food Items Prevalence

(%) Mean intake

(g/day) Food Items

Prevalence (%)

Mean intake (g/day)

White rice 97.2 289.7 White rice 89.8 297.9

Sugar 60.4 60.7 Sugar 55.9 25.5

Marine fish 40.9 11.6 Leafy green vege. 43.2 118.6

Leafy green vege. 40.0 50.6 Marine fish 29.4 102.6

Condensed milk 35.3 29.6 Chilies 24.2 25.8

Bread 17.1 36.1 Condensed milk 23.5 50.7

Full cream milk 17.1 18.5 Soy sauce 20.3 18.0

Biscuits 16.3 21.63 Condiment 14.6 19.4

Hen Egg 12.6 4.9 Hen egg 14.2 85.2

Anchovy 11.9 4.9 Cream crackers 12.9 43.4

Figure 10. Comparison prevalence and mean intake of the top ten food consumed daily among Malaysian adult between MANS 2003 and MANS 2014

Key Findings MANS 2014 Food Consumption pattern

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Key Findings MANS 2014 Nutritional Status

Figure 11. Prevalence of nutritional status of Malaysian adults.

6.2

42.9

32.4

18.5 Obesity

Overweight

Normal

Underweight

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Key Findings MANS 2014 Nutritional Status

Figure 11. Changes in prevalence of nutritional status of Malaysian adult from

MANS 2003 & MANS 2014

9.0 6.2

52.1

42.9

26.7

32.4

12.2

18.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

MANS 2003 MANS 2014

Pre

vale

nce

(%

)

Underweight

Normal

Overweight

Obese

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Key Findings MANS 2014 Nutrient Intake

Figure 12. Median energy intake per day of Malaysian adults by overall and different in strata & gender

1466

1510

1428

1489

1445

1380

1400

1420

1440

1460

1480

1500

1520

Urban Rural Men Women

Malaysia Strata Gender

Ener

gy in

take

(kc

al/d

ay)

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Key Findings MANS 2014 Nutrient Intake

Figure 15. Percentage contribution of daily energy intake from macronutrients

58.53 54.12

14.31 15.2

26.78 28.93

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2003 2014

Perc

enta

ge (

%)

Carbohydrate Protein Fat

MANS MANS

14

66

Kca

l/d

ay

15

40

Kca

l/d

ay

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• About quarter of Malaysian household exposed to risk of food insecurity.

• Most Malaysian adults took meal during dinner and the

prevalence those who took meal after dinner also alarming. • The intake of vegetables, legumes (legumes product) and

milk (milk product) among Malaysian adults was insufficient as suggested by Malaysia Food Pyramid recommendation.

Discussion

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• Half of Malaysian adults never read the food label or nutrition information panel when buy or received food.

• About 3 quarters of Malaysia adults had been taking any type of supplements (VMS and FS) within the past one year.

• Approximately 7.1 million Malaysian adults were physically inactive, which represented 36.9% of the adult population.

Discussion

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• From the food consumption pattern, consumption of “processed foods” and condiments had increased rapidly as daily top ten food most consumed in Malaysian adults.

• About half of the Malaysian adult population found to having excess

body weight (overweight and obese) • Reported daily energy intake of Malaysian adults was about

1500kcal/day. As diets very considerably from day to day, the ability of a single 24HR to provide an accurate estimation of long term energy intake is limited (Ma Y. et al. 2009). Korean National Health & Nutrition Examination Survey reported high underreporting with 24HR especially among individual with BMI ≥25 and poor self-rated health (Kye S et al. 2014).

Discussion

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• In conclusion, this survey found the greatest concern should be placed on nutrition status of Malaysian population when in proportion, one in two adults in Malaysian was overweight or obese. High prevalence of physical inactivity, insufficient vegetables, legumes and milk intake, habit to take heavy meal after dinner, high prevalence of never read food label and high risk of household food insecurity also need many attentions.

Conclusion

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• As half of Malaysian adults was categorised as overweight

and obese, effective and holistic efforts from multi-sectorial agencies is urgently needed to intervene this problem.

• Regular nutrition surveys should be carried out to provide

comprehensive information on trends in food and nutrient intake among Malaysian population.

Recommendation

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1. Malik, V. S., Pan, A., Willett, W. C., & Hu, F. B. (2013). Sugar-sweetened beverages and

weight gain in children and adults: a systematic review and meta-analysis. The American journal of clinical nutrition, 98(4), 1084-1102.

2. A Karim, N., Mohd Yusof, S., Hashim, J. K., Din, M., Haslinda, S., Harun, Z., ... & Sulong, F. (2008). Food consumption patterns: findings from the Malaysian Adult Nutrition Survey (MANS). Malaysian Journal of Nutrition, 14(1), 25-39.

3. Habitual Food Intake od Adults Aged 18 to 59 Years. Report Malaysian Adult Nutrition Survey 2003. Ministry of Health Malaysia.

4. Tee, E. (2011). Development and promotion of Malaysian dietary guidelines.Asia Pacific journal of clinical nutrition, 20(3), 455.

5. Ma, Y., Olendzki, B. C., Pagoto, S. L., Hurley, T. G., Magner, R. P., Ockene, I. S., ... & Hébert, J. R. (2009). Number of 24-hour diet recalls needed to estimate energy intake. Annals of epidemiology, 19(8), 553-559.

6. Kye, S., Kwon, S. O., Lee, S. Y., Lee, J., Kim, B. H., Suh, H. J., & Moon, H. K. (2014). Under-reporting of energy intake from 24-hour dietary recalls in the Korean National Health and Nutrition Examination Survey. Osong public health and research perspectives, 5(2), 85-91.

References

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Data Collection MANS 2014

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Report writing workshop

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Kindly refer to IKU website for detail in every scopes of this survey. (http://www.iku.gov.my/).

MANS 2014

General Finding

Food Security

Meal Pattern

Food Intake by Food GROUP

Habits to Relation to Food

Consumption

Food Labelling

Nutrient

Intake

Nutritional Status

Vitamin & Mineral

Suplements

Food Habit

MANS 2014

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THANK YOU

MANS 2014

General Finding

Food Security

Meal Pattern

Food Intake by Food GROUP

Habits to Relation to Food

Consumption

Food Labelling

Nutrient

Intake

Nutritional Status

Vitamin & Mineral

Suplements

Food Habit