Key Findings of the Recent Malaysian Adult Nutrition Survey (MANS) 2014 Presenter : Mohamad Hasnan Bin Ahmad Nutritionist Institute For Public Health Ministry of Health 50590 Jalan Bangsar, Kuala Lumpur 1
Introduction 1 st Malaysian Adult Nutrition Survey (MANS) was carried out in 2003. It was conducted as a nationwide survey, covering Peninsular Malaysia, Sabah & Sarawak. 2
Introduction The report was published in 8 volumes 3
Introduction 2 nd 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. 4
Objectives 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. 5
Objectives 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. 6
Methodology 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. 7
Methodology 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. 8
Key Findings MANS 2014 Out of 4,044 sampled household, 3,574 completed the household questionnaire (household response rate was 88.4%) 9
Key Findings MANS 2014 Food Security 1. Ever experience food quantity insufficiency. 24.9 2. Ever experience food variety insufficiency. 25.5 3. Adult family members had REDUCED the size of meals. 21.9 4. Adult family members had SKIPPED the main meals. 15.1 5. Only rely on cheap and affordable foods to feed children. 23.7 6. Could not afford to feed the children with various foods. 20.8 Malaysian households were at risk for food insecurity by exploratory factor analysis 24.8 0 5 10 15 20 25 30 Prevalence (%) Figure 1. National status of food insecurity based on individual parameters. 10
Prevalence (%) Key Findings MANS 2014 Meal Pattern 120 100 93.7 94.5 96.4 80 60 40 31.9 20 0 Breakfast (7.00am - 10.30am) Lunch (12.00noon - 2.30pm) Dinner (6.00pm - 9.00pm) Heavy meal after dinner Meals Figure 2. Prevalence of Meal consumption pattern of Malaysian adults. 11
Prevalence (%) Key Findings MANS 2014 Meal Pattern 98.0 96.0 96.4 94.0 92.0 92.0 94.5 93.7 Breakfast (7.00am - 10.30am) 90.0 88.0 89.2 88.6 Lunch (12.00noon - 2.30pm) Dinner (6.00pm - 9.00pm) 86.0 84.0 MANS 2003 MANS 2014 Figure 3. Comparison prevalence of meal consumption pattern of between MANS 2003 & MANS 2014 12
Meal serving/day Key Findings MANS 2014 Food Intake By Food Group 5.0 4.5 4.4 4.0 3.5 3.0 2.5 2.0 2.0 2.5 1.7 2.1 1.5 1.0 0.5 0.0 Cereal and cereal product Figure 4. Mean serving intake in a day according to food group among Malaysian adults. Vegetables Fruits Meat, poultry and egg Fish and fish product 0.3 0.4 Legumes and legume product Milk and Milk product 13
Key Findings MANS 2014 Food Label Always Read 23 Never read 55 Sometimes read 22 Figure 5. Prevalence of food label reading among Malaysian adults. 14
Prevalence (%) Key Findings MANS 2014 Dietary Supplement 40 35 34.1 30 28.1 25 20 15 15.6 10 5 0 Vitamin & mineral supplement (VMS) Food supplement (FS) VMS & FS Figure 6. Prevalence of vitamin & mineral supplement (VMS) and food supplement (FS) among Malaysian adults. 15
Prevalence (%) 40 35 30 25 20 15 10 5 0 Key Findings MANS 2014 Dietary Supplement 34.0 28.1 24.8 23.9 MANS 2003 MANS 2014 Vitamin and Mineral Supplement Food Supplement Figure 7. Comparison prevalence of vitamin & mineral supplement (VMS) and food supplement (FS) intake between MANS 2003 and MANS 2014. 16
Key Findings MANS 2014 Physical Activity Physically Inactive 36.9 Physically Active 63.1 Figure 8. Prevalence of physical activity status of Malaysian adults. 17
Prevalence (%) Key Findings MANS 2014 Food Consumption Pattern 100 90 80 70 60 50 40 30 20 10 0 89.8 55.9 43.2 29.4 24.2 23.5 White rice Sugar Leafy green Marine fish Chilies Condensed vege. milk 20.3 14.6 14.2 12.9 Soy sauce Condiment Hen egg Cream creakers Food item Figure 9. Prevalence of the top ten foods consumed daily among Malaysian adults population. 18
Key Findings MANS 2014 Food Consumption pattern Food Items MANS 2003 MANS 2014 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 19
Key Findings MANS 2014 Nutritional Status Obesity 18.5 6.2 Underweight Normal Overweight 42.9 32.4 Figure 11. Prevalence of nutritional status of Malaysian adults. 20
Prevalence (%) Key Findings MANS 2014 Nutritional Status 60.0 52.1 50.0 42.9 40.0 32.4 Underweight 30.0 26.7 Normal 20.0 12.2 18.5 Overweight Obese 10.0 9.0 6.2 0.0 MANS 2003 MANS 2014 Figure 11. Changes in prevalence of nutritional status of Malaysian adult from MANS 2003 & MANS 2014 21
Energy intake (kcal/day) Key Findings MANS 2014 Nutrient Intake 1520 1510 1500 1489 1480 1460 1440 1466 1428 1445 1420 1400 1380 Urban Rural Men Women Malaysia Strata Gender Figure 12. Median energy intake per day of Malaysian adults by overall and different in strata & gender 22
Percentage (%) 1540 Kcal/day 1466 Kcal/day Key Findings MANS 2014 Nutrient Intake Carbohydrate Protein Fat 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MANS 26.78 28.93 14.31 15.2 58.53 54.12 2003 MANS 2014 Figure 15. Percentage contribution of daily energy intake from macronutrients 23
Discussion 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. 24
Discussion 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. 25
Discussion 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). 26
Conclusion 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. 27
Recommendation 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. 28
References 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). Underreporting 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. 29
Data Collection MANS 2014 30
Report writing workshop 31
MANS 2014 General Finding Food Security Meal Pattern MANS 2014 Kindly refer to IKU website for detail in every scopes of this survey. (http://www.iku.gov.my/). Food Intake by Food GROUP Habits to Relation to Food Consumption Food Labelling Vitamin & Mineral Suplements Food Habit Nutritional Status Nutrient Intake 32
MANS 2014 General Finding Food Security Meal Pattern Food Intake by Food GROUP Habits to Relation to Food Consumption Food Labelling Vitamin & Mineral Suplements THANK YOU Food Habit Nutritional Status Nutrient Intake 33