MANS_Energy and Nutrient Intakes
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Mal J Nutr 14 (1): 1 - 24, 2008 Energy and Nutrient Intakes: Findings from the Malaysian Adult Nutrition Survey (MANS) Mirnalini K 1 , Zalilah MS 1 , Safiah MY 2 , Tahir A 3 , Siti Haslinda MD 4 , Siti Rohana D 5 , Khairul Zarina MY 2 , Mohd Hasyami S 2 & Normah H 2 1 Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia 2 Family Health Division, Ministry of Health Malaysia 3 Institute for Health System Research, Kuala Lumpur, Malaysia 4 Research and Development Division, Statistics Department, Putrajaya, Malaysia 5 Department of Health, Kedah, Malaysia ABSTRACT Nutrition surveys based on a representative sample of the Malaysian adult population have hitherto not been reported. In 2003, the Ministry of Health, Malaysia, conducted the Malaysian Adult Nutrition Survey (MANS), the first and largest nutrition survey in the country which aimed to provide detailed quantitative information on nutritional status, food and nutrient intakes, and physical activity pattern on a nationwide representative sample of adult subjects between the ages of 18 and 59 years. The survey covered four zones in Peninsular Malaysia (Central, Southern, Northern and East Coast), Sabah and Sarawak. This paper presents the mean and selected percentiles of energy and nutrient intake of 6886 subjects by selected demographic and socioeconomic characteristics. Energy contributions by macronutrients and dietary adequacy in relation to the Recommended Nutrient Intake for Malaysians are also described. Information on dietary intake was collected by trained nutritionists using a one day 24-hour diet recall. Dietary data were analysed using Nutritionist Pro, a diet analysis software and statistical analysis was carried out using the SPSS ver. 13.0. In most of the demographic and socioeconomic groups, males had higher mean energy (1776 kcal) and nutrient intake and percent achievement of RNI than females (1447 kcal). The proportions of calories derived from macronutrients were within the recommendations for a healthy diet. Intake of micronutrients such as iron, calcium and vitamin A was about 50% of RNI particularly in women. Sodium intake of Malaysians, not reported in earlier studies, is also made available. Under-reporting using the EI/BMR ratio was found in half of the population studied. The present study provides the first national estimates of energy and nutrient intake of the Malaysian adult population. Regular nutrition surveys are needed at the national level to provide valuable information on trends in food and nutrient intake, particularly among age and ethnically diverse subgroups of the population. Correspondence author: Prof Assoc Dr Mirnalini Kandiah; Email: [email protected]
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Transcript of MANS_Energy and Nutrient Intakes
Mal J Nutr 14 (1): 1 - 24, 2008
Energy and Nutrient Intakes: Findings from the MalaysianAdult Nutrition Survey (MANS)
Mirnalini K1 , Zalilah MS 1 , Safiah MY 2 , Tahir A3, Siti Haslinda MD4, Siti Rohana D5,Khairul Zarina MY2, Mohd Hasyami S2 & Normah H2
1 Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti PutraMalaysia, 43400 UPM Serdang, Selangor, Malaysia
2 Family Health Division, Ministry of Health Malaysia3 Institute for Health System Research, Kuala Lumpur, Malaysia4 Research and Development Division, Statistics Department, Putrajaya, Malaysia5 Department of Health, Kedah, Malaysia
ABSTRACT
Nutrition surveys based on a representative sample of the Malaysian adultpopulation have hitherto not been reported. In 2003, the Ministry of Health,Malaysia, conducted the Malaysian Adult Nutrition Survey (MANS), the firstand largest nutrition survey in the country which aimed to provide detailedquantitative information on nutritional status, food and nutrient intakes, andphysical activity pattern on a nationwide representative sample of adult subjectsbetween the ages of 18 and 59 years. The survey covered four zones in PeninsularMalaysia (Central, Southern, Northern and East Coast), Sabah and Sarawak. Thispaper presents the mean and selected percentiles of energy and nutrient intake of6886 subjects by selected demographic and socioeconomic characteristics. Energycontributions by macronutrients and dietary adequacy in relation to theRecommended Nutrient Intake for Malaysians are also described. Information ondietary intake was collected by trained nutritionists using a one day 24-hour dietrecall. Dietary data were analysed using Nutritionist Pro, a diet analysis softwareand statistical analysis was carried out using the SPSS ver. 13.0. In most of thedemographic and socioeconomic groups, males had higher mean energy (1776kcal) and nutrient intake and percent achievement of RNI than females (1447kcal). The proportions of calories derived from macronutrients were within therecommendations for a healthy diet. Intake of micronutrients such as iron, calciumand vitamin A was about 50% of RNI particularly in women. Sodium intake ofMalaysians, not reported in earlier studies, is also made available. Under-reportingusing the EI/BMR ratio was found in half of the population studied. The presentstudy provides the first national estimates of energy and nutrient intake of theMalaysian adult population. Regular nutrition surveys are needed at the nationallevel to provide valuable information on trends in food and nutrient intake,particularly among age and ethnically diverse subgroups of the population.
Correspondence author: Prof Assoc Dr Mirnalini Kandiah; Email: [email protected]
2 Mirnalini K et al.
INTRODUCTION
The stable economic growth and politicalclimate in Malaysia during the last threedecades have greatly contributed toimproved socio-economic status of itspopulation and has led to significant lifestyleand dietary changes. Food disappearancedata of the last three decades show markedupward shifts in the availability of dietaryenergy, total fat and protein, refinedcarbohydrate and animal products (Tee,1999). These changes and a high rate ofphysical inactivity (MOH, 2006) have beenimplicated as factors contributing to theincreasing rate of obesity and other nutrition-related non-communicable diseases amongMalaysian adults (Ng, Tee & Rosman, 1995;MOH, 1999; Khor et al., 1999; Lim et al., 2000).Consequently, there is a need forcomprehensive information on the actualdietary intake of Malaysian adults.
Information on the diet of thepopulation is essential for the formulation,implementation and monitoring of effectivepolicies and programmes designed toimprove overall nutritional well-being andhealth status. Between 2002 and 2003, theMinistry of Health carried out the MalaysianAdult Nutrition Survey, a cross-sectionalsurvey that was conducted for the first timeon a representative sample of the Malaysianadult population. This landmark surveycovered four zones in Peninsular Malaysiaand included Sabah and Sarawak. Themain objective of this survey was todetermine the nutritional status, food andnutrient consumption and physical activitypattern of Malaysian adults.
The 24-hour diet recall (24-HDR) aquantitative estimate of all foods andbeverages an individual consumes theprevious day covering 24-hour duration hasbeen the method of choice in many nationaldietary surveys such as the New Zealand
National Nutrition Survey (Russell et al.,1999), National Nutrition Survey of Japan(Yoshiike et al.,1996), the US NationalHealth and Nutrition Examination Survey(NHANES) (NCHS, 1994), and theContinuing Survey of Food Intakes byIndividuals (CSFI II/DHSK, 1997). Thisinterviewer or telephone administereddietary assessment method providescomplete self–reported information for groupintake for a given day and has beenrecognised as being accurate (Gibson, 2005;Subar, 2004). The 24-HDR was used toobtain dietary data in the Malaysian AdultsNutrition Survey (MANS). The purpose ofthis paper is to report the intake of energyand nutrients, energy contribution frommacronutrients and dietary adequacy ofMalaysians by demographic and socio-economic characteristics of the population.
MATERIALS AND METHODS
Survey design and sampling
The MANS survey utilised stratified randomsampling which covered Sabah, Sarawakand four zones in Peninsular Malaysia(Southern, Central, East Coast and Northern).The eligible respondents of this survey wereMalaysian adults aged 18 to 59 years old.Sample size was determined using threefactors which were: the estimated prevalenceof obesity and overweight (21%) from theSecond National Health and MorbiditySurvey (NHMS 11, 1996), 95% as the desiredlevel of confidence and a 5% margin of error.The minimum sample size required was5,780. The sampling frame was provided bythe Department of Statistics and comprisedEnumeration Blocks (EB) and LivingQuarters (LQ) which were sampledproportionate to the population size. Toaccount for a non-response rate of 50%, therequired sample size was increased to 8,670.
3MANS, Energy and Nutrient Intakes
A pre-survey of the selected LQs was carriedout to scout and locate the selected houses,and to obtain information on the householdmembers such as age, sex and ethnic group.Information on the status of houses whichwere demolished, destroyed, did not exist orchanged status was used to determine theactual number of eligible respondents.Eligibility was defined as being agedbetween 18 and 59 years and not pregnantor breastfeeding at the time of the interview.Where there was more than one adult in thisgroup living in the same household, onlyone was selected at random to take part inthe survey.
Subjects
A total sample of 7349 adults (51% men and49% women) corresponding to the totalestimated population of 14,178,135 wereinterviewed at their homes.
Measurements
Socio-demographic variables
A pre-tested questionnaire was used toobtain socio-demographic informationwhich included gender, ethnicity (Malay,Chinese, Indian including Punjabi, OrangAsli of Peninsular. Malaysia, SabahBumiputra, Sarawak Bumiputra, and otherBumiputra), age group (18-19, 20-39, 40-49,50-59), educational level (primary school,lower secondary school, higher secondaryschool, matriculation/form six, college/university and others: no formal educatione.g. religious schooling), strata (rural: smalltowns, villages /urban: metropolitans,cities) and four zones in PeninsularMalaysia (Southern: Negeri Sembilan,Melaka, Johor; Central: Perak, Selangor,Wilayah Persekutuan; East-Coast: Kelantan,
Terengganu, Pahang; Northern: Perlis,Kedah, Pulau Pinang), Sabah and Sarawak.
Dietary assessment
Dietary data were obtained from aninteractive 24-hour dietary recall methodthat was adapted from Gibson and Ferguson(1999) and the Continuing Survey of FoodIntakes by Individuals (CSFI II/DHSK, 1997).This is an improved approach for collectingdietary intake wherein respondents areasked to recall all foods and beveragesconsumed over the previous 24-hr timeperiod (midnight to midnight) in anuninterrupted manner (the quick list).Respondents are then probed for the typesof foods and preparation method,ingredients and amounts for each food itemmentioned in the quick list. To help therespondent in recalling foods that arefrequently forgotten, the interviewer readsout a list of foods that include alcoholic andnon-alcoholic beverages, fruit, and snackitems. After all foods and fluids consumedare specified, the interviewer reviews theentire recall with the respondent as a finalcheck for completeness and accuracy. The24-HDR was interviewer-administered bynutritionists trained in interviewing andprobing skills, quantification of portion sizesof foods and who are also familiar with localfood customs. In addition, data entry clerkswho were trained to identify, describe foodsand recipes and carry out quality controlchecks were used. Dietary assessment aidssuch as the album of food pictures (MOH,2004) and household measures were usedto facilitate identi-fication of foods andquantification of portion sizes consumed.The album consists of actual sizephotographs of individual foods which wereuseful in helping subjects estimate amounts
4 Mirnalini K et al.
these recipes were analysed using theMalaysian Food Composition Tables (Tee etal., 1997) and the average of these values wasentered into the Nutritionist Pro software.For example, two recipes of fish curry (gravy)were obtained and the ingredients wereanalysed for energy and nutrient values (per100 gram). The average values of the tworecipes were then used as the standard fornutrient content of fish curry. For processedand packaged foods, information on energyand nutrient content on their labels wasentered into the software directly foranalysis. For all foods consumed by thesubjects, steps were taken to ensure that oils,fats and salt were accounted for. The macro-and micro-nutrient intakes reported in thepresent paper are based exclusively on thecontribution of food and fluids consumedand do not include contribution fromvitamin and mineral supplements.
Dietary adequacy
Dietary adequacy was assessed bycomparison of energy and nutrient intakewith the Recommended Nutrient Intakes(RNIs) for Malaysians (NCFFN, 2005). Formacro-nutrients, adequacy was consideredachieved if the person’s mean intake met, ata minimum, the following guidelines: 20-30% of energy from total fat, 55% to 70%carbohydrate and 10-15% proteins. Formicro-nutrients (vitamins A, C, thiamine,iron, and calcium), adequacy was con-sidered achieved if the individual’s meanintake met or exceeded 100% of the RNI.
Evaluation of under-reporting
Under-reporting of energy is a major concernin dietary assessment (Black et al., 1991). The
eaten as fractions or multiples of theillustrated reference portions.
Dietary data analysis
Questionnaires were sent to the FamilyHealth Development Division, MOH forcentralised data entry to ensurestandardisation of the data managementprocess. Data cleaning and quality controlchecks were carried out before dietary intakeanalysis was performed. Completeinformation on diet and socio-economiccharacteristics was obtained from 6886adults (93.6% response rate). A dietaryanalysis software, Nutritionist Pro™Nutrition Analysis Software (First DataBank, USA, 2003)*, was used for energy andnutrient analysis. This software containsseveral food databases including the USDAFood Database, Canadian Food Database,Mexico Food Database and the MalaysianFood Composition Tables along with otherhundreds of international food items. Forfood items not available in Nutritionist Pro,other food databases such as the SingaporeFood Composition Guide (SingaporeMinistry of Health, 2001), ASEAN FoodComposition Tables (Puwastien, Burlingame& Raroenwichit, 2000) and The China FoodComposition Tables (Institute of Nutritionand Food Safety, China, 2002) were soughtfor energy and nutrient content. Theinformation was then entered into theNutritionist Pro for analyses. For localcomplex mixed cooked dishes that were notavailable in any of the food databases, localrecipe books were used to identify at leasttwo recipes for each dish. For each recipe, itwas ensured that the quantitativeinformation on oils, fats and salt wereavailable. Energy and nutrient content of
* The license for Nutritionist Pro™ Nutrition Analysis Software was taken over by Axxya Systemsin the United States, a developer of nutrition and fitness products, in 2005.
5MANS, Energy and Nutrient Intakes
ratio between reported total energy intake(EI) and basal metabolic rate (BMR) was usedto examine the prevalence of under-reportingof energy. BMR was calculated using theequation of Ismail et al. (1998). An EI/BMRratio below 1.2 was considered as inadequatefor the maintenance of body weight toidentify low energy reporters (Goldberg etal., 1991). In this population, it was found tobe 1.212 and half (54.8%) of the populationwere under-reporters. Women’s EI/BMRratio was lower than that of men (1.178 vs1.243) and more women (58%) than men(51%) were under-reporters. However, thispaper does not exclude under-reporters fromthe data set as the aim of this paper is topresent the energy and nutrient intakes ofthe whole sample.
Statistical analysis
Data on energy and nutrient intakes weretransferred from the Nutritionist Pro to theStatistical Package for Social Sciences (SPSS)version 13.0 for statistical analysis. Asampling weight was added to account forcomplex survey design, non-response andpost stratification for stratum, age and sexin the analysis for extrapolation of thefindings to the Malaysian population. Intakedistributions are presented as mean±SE,median, 25th and 75th percentiles tocharacterise population intake levels forgender, and socio-demographic charac-teristics (zone, strata, ethnicity, age andeducation level).
RESULTS
Socio-demographic profile
About 54% and 46% of the population wasfrom the urban (metropolitans and cities)and rural (towns, villages) areas,
respectively (Table 1). By ethnic distributionMalays constituted the majority (54%),followed by the Chinese (23%), and Indians(9.2%). Bumiputera Sarawak and Bumi-putera Sabah (Bumiputra groups other thanMalays) together comprised 11.2%, OtherBumiputra, 2.2% (Bumiputra groups otherthan Malays, Bumiputra Sabah, BumiputraSarawak) and Orang Asli of PeninsularMalaysia comprised 0.4%. Young adultsbetween the ages of 18 and 29 years formedthe biggest group (35.8%) while the smallestgroup was the oldest adults (13.2%). About75% of the population have achieved aboutsix to 11 years of education while a smallminority did not receive any formaleducation.
Energy
Table 2 presents the distribution of energyintake of Malaysian adults. The meanenergy intake of men was higher (1776 kcalor 74.5% of RNI) than that of women (1447kcal or 71.0% of RNI). In general, energyintake and percent RNI achievement in bothsexes declined gradually with age withwomen in all age groups having lowerachievements than men. By strata, rural andurban respondents had similar mean energyintakes. By zones, Sabah achieved thehighest mean energy intake while theCentral zone had the lowest. Among thethree major ethnic groups in Malaysia,Malays had the highest intake of energy(1653 kcal). When all ethnic groups wereconsidered, the mean energy intake ofBumiputra Sabah was the highest (1790kcal) and Orang Asli, the lowest (1066 kcal).Energy intake increased with educationallevel, being lowest in the Others group (1319kcal) and highest in the group with college/university education.
6 Mirnalini K et al.
Table 1. Socio-demograhic characteristics of the survey population (N=6886)
Characteristics Total (N=6886) Men (n=3327) Women (n=3559)
n (%) n (%) n (%)
Zone South 1,324 19.2 623 18.7 701 19.7 Central 2,312 33.6 1,154 34.7 1,158 32.5 East Coast 940 13.7 451 13.6 489 13.7 North 891 12.9 415 12.5 476 13.3 Sabah 721 10.5 355 10.7 366 10.3 Sarawak 698 10.1 329 9.9 369 10.4
Strata Urban 3,682 53.5 1,800 54.1 1,882 52.9 Rural 3,204 46.5 1,527 45.9 1,677 47.1
Age group (years) 18-19 427 6.2 208 6.3 219 6.2 20-29 2,039 29.6 989 29.7 1,050 29.5 30-39 1,974 28.7 907 27.3 1,067 30.0 40-49 1,537 22.3 767 23.1 770 21.6 50-59 909 13.2 456 13.6 453 12.7
Ethnic Group Malay 3,709 53.9 1,812 54.5 1,897 53.3 Chinese 1,590 23.1 756 22.7 834 23.4 Indian 632 9.2 299 9.0 333 9.4 Orang Asli SM 29 0.4 12 0.4 17 0.5 Bumiputera Sabah 389 5.7 187 5.6 202 5.7 Bumiputera Sarawak 384 5.5 189 5.7 195 5.4 Other Bumiputera 153 2.2 72 2.2 81 2.3
Educational Level Primary school 1,427 20.7 622 18.7 805 22.6 Lower secondary 1,472 21.4 791 23.8 681 19.1 school Upper secondary 2,296 33.3 1,129 33.9 1,167 32.8 school Matriculation/Form 6 359 5.2 139 4.2 220 6.2 College/University 970 14.1 548 16.5 422 11.9 Others 355 5.2 97 2.9 258 7.2
7MANS, Energy and Nutrient IntakesTa
ble
2. E
nerg
y in
take
(kc
al)
of
Mal
aysi
an a
dults
by
soci
o-de
mog
raph
ic c
hara
cter
istic
s an
d pe
rcen
t RN
I
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne1,
615
91,
540
1,18
81,
959
1,77
614
1,72
21,
348
2,11
61,
447
111,
400
1,07
11,
759
Sou
ther
n1,
571
201,
488
1,15
21,
880
1,73
229
1,69
61,
321
2,05
81,
401
231,
359
1,03
41,
677
C
entr
al1,
577
161,
484
1,15
21,
866
1,74
622
1,63
41,
312
2,05
11,
400
201,
339
1,02
01,
692
Eas
t Coa
st1,
686
271,
654
1,22
72,
072
1,83
342
1,83
31,
415
2,27
11,
530
341,
476
1,12
91,
912
N
orth
ern
1,57
023
1,50
41,
175
1,87
51,
711
321,
666
1,32
62,
038
1,43
631
1,38
21,
081
1,70
7 S
abah
1,77
635
1,67
91,
307
2,21
21,
915
581,
795
1,42
22,
335
1,62
940
1,54
31,
209
2,01
1 S
araw
ak1,
716
331,
652
1,27
62,
094
1,91
056
1,86
61,
472
2,24
41,
513
321,
476
1,14
41,
919
Stra
ta U
rban
1,60
112
1,51
21,
171
1,93
11,
760
181,
671
1,32
22,
080
1,43
715
1,37
91,
051
1,73
9 R
ural
1,63
514
1,57
51,
211
1,98
51,
800
221,
755
1,38
52,
167
1,46
317
1,42
31,
097
1,78
6A
ge G
roup
(yea
rs)
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191,
621
511,
571
1,16
12,
050
1,81
782
1,80
21,
369
2,25
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.51,
419
551,
355
994
1,94
171
.0 2
0-29
1,66
516
1,59
51,
221
2,00
51,
805
231,
759
1,37
02,
142
74.0
1,51
922
1,46
11,
100
1,81
976
.0 3
0-39
1,66
016
1,56
71,
237
1,99
51,
847
241,
773
1,40
92,
218
75.1
1,46
818
1,41
51,
105
1,77
667
.3 4
0-49
1,55
516
1,50
11,
148
1,89
01,
716
231,
657
1,31
42,
050
69.8
1,38
721
1,35
61,
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1,71
663
.6 5
0-59
1,50
321
1,44
31,
152
1,79
51,
638
301,
576
1,25
31,
983
66.6
1,36
028
1,35
11,
033
1,63
462
.4Et
hnic
Gro
up M
alay
1,65
313
1,57
91,
203
1,99
91,
817
181,
757
1,37
52,
141
1,47
917
1,41
61,
082
1,80
7
Chi
nese
1,56
716
1,49
21,
182
1,85
61,
729
241,
648
1,34
52,
048
1,40
320
1,35
91,
061
1,66
8 I
ndia
n1,
431
301,
370
1,05
71,
759
1,58
949
1,51
21,
175
1,91
71,
281
331,
256
949
1,59
1 O
rang
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1,06
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21,
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618
1,65
31,
119
275
1,36
965
22,
055
1,00
012
098
749
51,
294
Sab
ah B
umip
uter
a1,
790
441,
705
1,27
82,
250
2,00
962
1,83
71,
466
2,35
31,
580
531,
540
1,11
52,
012
Sar
awak
Bum
iput
era
1,69
238
1,64
11,
299
2,12
21,
813
581,
809
1,43
42,
185
1,56
748
1,48
41,
157
1,97
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ther
s Bu
mip
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a1,
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851,
557
1,30
02,
010
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663
1,30
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1,57
560
1,49
21,
278
1,74
3Ed
ucat
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l Lev
el P
rim
ary
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ol1,
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181,
439
1,11
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855
1,69
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252
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31,
382
201,
346
1,04
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Low
er S
econ
dary
Sch
ool1
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181,
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1,19
01,
942
1,75
124
1,68
81,
330
2,09
81,
430
261,
395
1,05
31,
737
Hig
her
Seco
ndar
y Sc
hool
1,67
217
1,61
61,
251
2,01
51,
824
241,
776
1,40
12,
160
1,51
221
1,47
61,
119
1,84
5
Mat
ricu
latio
n/Fo
rm 6
1,62
744
1,56
41,
205
2,09
41,
848
661,
815
1,39
42,
271
1,48
354
1,43
71,
102
1,89
4
Col
lege
/Uni
vers
iti1,
693
261,
600
1,24
82,
006
1,84
637
1,77
31,
413
2,14
41,
473
301,
395
1,10
51,
754
Oth
ers
1,31
938
1,34
899
31,
668
1,35
388
1,42
81,
106
1,76
81,
303
381,
314
955
1,62
1
8 Mirnalini K et al.Ta
ble
3. C
arbo
hydr
ate
inta
ke (
g) o
f M
alay
sian
adu
lts b
y so
cio-
dem
ogra
phic
cha
ract
eris
tics
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
2575
2575
2575
Mal
aysi
a Zo
ne23
21.
422
116
928
425
62.
024
619
331
020
61.
6719
815
325
3 S
outh
ern
224
2.9
210
162
270
246
4.2
239
185
300
201
3.52
190
147
242
C
entr
al22
52.
421
216
327
325
13.
323
618
829
919
82.
8818
814
524
4 E
ast C
oast
250
3.9
242
185
308
274
5.8
270
207
341
224
5.00
218
165
277
N
orth
ern
226
3.4
215
164
273
249
4.9
242
189
298
205
4.52
194
152
245
Sab
ah25
85.
024
318
931
028
28.
527
021
334
123
24.
9522
217
427
7 S
araw
ak23
94.
422
917
728
926
86.
725
320
331
920
94.
5420
515
725
8St
rata
Urb
an22
61.
821
316
327
425
02.
623
918
830
220
12.
2119
114
724
5 R
ural
240
2.1
231
176
294
266
3.2
254
200
322
214
2.50
209
159
262
Age
Gro
up (y
ears
) 1
8-19
232
7.2
220
159
301
263
11.0
252
184
328
199
8.41
185
139
254
20-
2923
82.
422
817
128
925
93.
425
019
731
321
53.
1020
415
426
3 3
0-39
239
2.4
228
176
290
268
3.6
256
203
323
210
2.68
204
159
256
40-
4922
32.
321
416
827
624
83.
323
818
830
419
82.
9119
214
624
5 5
0-59
217
3.1
208
163
261
237
4.3
229
182
294
197
4.16
185
151
239
Ethn
ic G
roup
Mal
ay24
21.
923
217
629
526
82.
725
620
332
121
52.
4820
715
626
3
Chi
nese
209
2.2
197
157
250
232
3.3
222
178
277
186
2.65
177
143
219
Ind
ian
212
4.5
207
155
262
234
7.1
223
174
291
190
4.96
188
142
239
Ora
ng A
sli P
M19
620
.921
513
428
419
832
.825
514
630
819
325
.12
162
9324
8 S
abah
Bum
iput
era
263
6.7
253
195
317
296
10.2
287
218
347
231
7.17
227
172
281
Sar
awak
Bum
iput
era
241
5.3
231
185
287
261
7.9
249
200
316
221
6.63
221
177
269
Oth
ers
Bum
iput
era
244
11.7
234
186
291
260
21.7
257
196
314
226
8.46
216
182
254
Educ
atio
nal L
evel
Pri
mar
y Sc
hool
223
2.7
211
163
274
252
4.4
239
185
308
200
2.99
194
149
247
Low
er S
econ
dary
231
2.7
220
169
284
251
3.7
243
189
310
204
3.70
196
147
253
Sc
hool
H
ighe
r Se
cond
ary
240
2.5
230
177
292
264
3.6
252
202
318
216
3.09
207
158
263
Sc
hool
Mat
ricu
latio
n/23
16.
722
317
129
326
710
.625
320
233
120
77.
7419
715
525
7 F
orm
6
Col
lege
/Uni
vers
iti23
33.
622
116
728
525
74.
924
519
130
620
04.
3819
115
124
7 O
ther
s20
35.
120
315
624
921
510
.321
717
527
219
75.
8219
915
224
2
9MANS, Energy and Nutrient Intakes
Macronutrients
The mean carbohydrate intake of Malaysianadults was approximately 232g (Table 3)which contributed to 59% of the total energyintake. By strata, rural adults had a highermean carbohydrate intake (240g) than theirurban counterparts (226g). Mean carbo-hydrate intake was highest in Sabah (258g)and lowest in the Southern zone (224g). TheOrang Asli had the lowest carbohydrateintake (196g) among all the ethnic groups.Carbohydrate intake declined with age anda similar trend was observed for educationallevel.
Malaysian adults recorded a meanprotein intake of 59g (14% of total energyintake) and men’s intake was higher by 10gover that of women (Table 4). Rural andurban adults were similar in their intake ofprotein. However, by zone, mean proteinintake ranged from lowest in Southern andCentral (57g) to highest in Sarawak (68g).RNI achievement for protein intake in bothmen and women was high, being above the75th percentile. Ethnic differences wereobserved with protein intake being highestin Bumiputra Sarawak (67g) and lowest inthe Orang Asli (27g). By educational level,the lowest intake of protein was observed inthe Others group.
Mean fat intake was estimated to beabout 50g for the whole population while adifference of 9g was noted between men andwomen. A similarity in fat intake was notedfor rural and urban residents (Table 5). Byzone, fat intake was lowest in Northern zone(47g) and highest in Sabah and Sarawak(53g). The youngest age group recorded thehighest intake (49g) while the lowest intakewas in the oldest age group (41g). By ethnicgroups, Chinese had the highest fat intake(53g) while the Orang Asli had the lowest(18g), recording a difference of 35g. By agegroup, a decline in fat intake was observed
with advancing age but it increased witheducational level.
Micronutrients
Calcium
Malaysian adults recorded a mean intake ofabout 397mg for calcium (Table 6) with ruraland urban adults having a similar intake.Calcium consumption was lowest for theyoungest age group in both sexes with RNIachievement ranging from 40-48% in womenand from 48-54% in men. By zone, meancalcium intake ranged from 384mg in Sabahto 425mg in Sarawak. Across ethnic groups,Orang Asli had the lowest intake of calcium(274mg) while Bumiputra Sarawak had thehighest intake (394mg) followed by theChinese (362mg). An increase in calciumintake was observed with higher levels ofeducation.
Iron
The mean intake of iron among Malaysianadults was about 10.7mg with men havinga higher intake (12mg) than women (9.5mg)(Table 7). By age group and gender, RNIachievement was lower in women than inmen in all age groups with the exception ofthe oldest group, being <36%. RNIachievement in men exceeded 75% of intake.By zone, intake varied on average by about1mg. By ethnic group, Orang Asli had theleast iron intake (5.5mg) followed by Indiansand Other Bumiputras. Iron intakeappeared to increase with educational level.
Vitamin CThe mean intake of vitamin C of therespondents was about 61mg with women’sintake being higher than that of men (Table8). Percentage RNI achievement for vitaminC was higher in men in all age groups ( 80 -105%) compared to that of women (63-95%).
1 0 Mirnalini K et al.Ta
ble
4. P
rote
in i
ntak
e (g
) of
Mal
aysi
an a
dults
by
soci
o-de
mog
raph
ic c
hara
cter
istic
s an
d pe
rcen
t R
NI
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne59
0.4
5541
7464
0.6
6046
7854
0.5
5037
68 S
outh
ern
571.
053
3970
611.
657
4475
521.
148
3665
C
entr
al57
0.7
5239
6962
0.9
5744
7551
1.0
4634
63 E
ast C
oast
611.
157
4276
661.
863
4880
561.
453
3872
N
orth
ern
601.
056
4374
651.
460
4677
561.
453
4068
Sab
ah65
1.4
6144
8170
2.3
6548
8561
1.7
5741
77 S
araw
ak68
1.6
6346
8475
2.6
7052
9261
1.6
5642
76St
rata
Urb
an59
0.6
5540
7264
0.8
5945
7754
0.7
5037
68 R
ural
600.
656
4275
651.
062
4780
540.
751
3869
Age
Gro
up (y
ears
) 1
8-19
592.
356
3974
653.
762
4681
104.
853
2.6
4934
6996
.4 2
0-29
610.
756
4175
641.
060
4679
103.
357
1.0
5238
7110
3.6
30-
3961
0.7
5742
7567
1.1
6348
8110
8.1
550.
952
3868
100.
0 4
0-49
580.
754
4073
631.
059
4576
101.
653
1.0
4936
6896
.4 5
0-59
560.
952
4068
611.
357
4473
98.4
511.
349
3664
92.7
Ethn
ic G
roup
Mal
ay59
0.6
5541
7364
0.8
5946
7754
0.7
5137
68
Chi
nese
620.
857
4475
671.
162
4981
571.
252
3970
Ind
ian
481.
245
3359
532.
049
3767
431.
241
3052
Ora
ng A
sli P
M27
6.1
187
4831
11.5
458
8322
4.7
176
39 S
abah
Bum
iput
era
641.
761
4481
722.
569
5089
572.
253
3974
Sar
awak
Bum
iput
era
671.
963
4584
712.
967
4989
632.
561
3978
Oth
ers
Bum
iput
era
633.
258
4278
635.
564
3979
623.
155
4275
Educ
atio
nal L
evel
Pri
mar
y Sc
hool
570.
853
3971
621.
258
4376
521.
049
3765
Low
er S
econ
dary
590.
855
4173
631.
159
4578
541.
250
3667
Sch
ool
H
ighe
r Se
cond
ary
610.
757
4275
651.
161
4878
560.
953
3872
Sch
ool
M
atri
cula
tion/
Form
659
1.6
5840
7864
2.5
6245
8656
2.1
5535
74
Col
lege
/Uni
vers
iti64
1.4
5744
7669
1.9
6347
8257
1.8
5138
66 O
ther
s46
1.9
4532
6145
4.6
4837
6447
1.8
4431
61
1 1MANS, Energy and Nutrient IntakesTa
ble
5. F
at i
ntak
e (g
) of
Mal
aysi
an a
dults
by
soci
o-de
mog
raph
ic c
hara
cter
istic
s
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
2575
2575
2575
Mal
aysi
a Zo
ne50
0.4
4631
6354
0.6
5035
6845
0.5
4128
58So
uthe
rn50
0.8
4532
6455
1.2
5337
6943
0.9
3927
55
Cen
tral
500.
645
3161
540.
949
3567
450.
841
2857
Eas
t Coa
st49
1.1
4631
6452
1.7
5035
6745
1.4
4228
58
Nor
ther
n47
0.9
4430
6051
1.3
4734
6344
1.3
4128
56 S
abah
531.
547
3167
552.
349
3269
502.
045
3064
Sar
awak
531.
649
3269
582.
955
3677
481.
545
3064
Stra
ta U
rban
510.
547
3265
560.
851
3669
460.
642
3060
Rur
al48
0.6
4530
6252
0.9
5034
6843
0.7
4027
56A
ge G
roup
(yea
rs)
18-
1951
2.1
4932
6956
3.7
5735
7446
1.9
4227
65 2
0-29
520.
748
3367
560.
952
3771
480.
945
3061
30-
3951
0.6
4532
6456
1.0
5137
7045
0.8
4230
59 4
0-49
480.
743
3060
531.
148
3565
431.
039
2654
50-
5945
1.0
4129
5849
1.4
4631
6341
1.2
3826
54Et
hnic
Gro
up M
alay
490.
545
3163
540.
850
3567
450.
641
2858
C
hine
se53
0.8
4934
6758
1.2
5439
7248
1.0
4432
62 I
ndia
n44
1.3
4027
5648
2.1
4430
6039
1.5
3624
50 O
rang
Asl
i PM
186.
114
232
2111
.416
271
153.
514
226
Sab
ah B
umip
uter
a52
1.8
4628
6857
2.4
5232
7347
2.5
4326
63 S
araw
ak B
umip
uter
a50
1.7
4530
6351
2.5
4832
6748
2.1
4326
62 O
ther
s Bu
mip
uter
a48
3.3
4329
6149
5.7
4328
6847
2.9
4232
57Ed
ucat
iona
l Lev
el P
rim
ary
Scho
ol44
0.8
4027
5748
1.3
4429
6341
0.9
3826
52 L
ower
Sec
onda
ry50
0.8
4531
6354
1.1
4934
6944
1.1
4028
57 S
choo
l
Hig
her
Seco
ndar
y52
0.7
4834
6556
1.0
5238
6947
0.8
4431
60 S
choo
l
Mat
ricu
latio
n/Fo
rm 6
521.
850
3269
582.
656
4072
482.
446
2766
C
olle
ge/U
nive
rsiti
561.
150
3568
601.
656
3973
501.
345
3261
Oth
ers
361.
733
2251
344.
133
2252
361.
633
2151
1 2 Mirnalini K et al.Ta
ble
6. C
alci
um i
ntak
e (m
g) o
f M
alay
sian
adu
lts b
y so
cio-
dem
ogra
phic
cha
ract
eris
tics
and
perc
ent
RN
I
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne39
7.2
3.5
353
233
514
418.
45.
037
425
253
837
5.3
4.8
334
217
485
Sou
ther
n40
8.6
8.8
364
246
527
420.
211
.638
326
854
539
6.2
13.3
338
226
513
C
entr
al38
7.8
5.5
344
228
502
416.
07.
937
024
753
335
8.1
7.4
324
212
456
Eas
t Coa
st41
3.8
9.4
367
231
548
435.
713
.540
825
858
839
0.8
13.2
335
210
511
N
orth
ern
382.
49.
133
122
548
340
6.5
13.3
346
239
507
359.
712
.131
820
845
1 S
abah
383.
69.
833
921
748
739
8.4
14.3
342
217
503
367.
913
.033
821
647
4 S
araw
ak42
5.4
12.8
389
261
548
437.
021
.341
327
555
441
3.3
13.6
369
236
536
Stra
ta U
rban
398.
94.
635
123
451
141
8.9
6.7
373
249
532
378.
36.
233
422
348
2 R
ural
394.
75.
335
523
051
841
7.6
7.5
377
255
544
370.
97.
433
321
449
1A
ge G
roup
(yea
rs)
18-
1935
8.8
15.7
332
207
473
390.
524
.936
824
152
248
.832
6.0
18.7
294
180
416
40.8
20-
2940
6.4
6.5
353
236
525
424.
68.
936
725
155
853
.138
7.4
9.3
338
224
493
48.4
30-
3940
7.8
5.7
367
237
526
429.
58.
739
325
555
353
.738
5.8
7.1
342
224
505
48.2
40-
4938
4.7
6.0
347
236
491
401.
68.
036
125
251
150
.236
6.9
9.0
329
220
463
45.9
50-
5940
5.0
10.2
353
222
512
429.
912
.937
525
652
553
.737
8.7
15.9
326
191
483
47.3
Ethn
ic G
roup
Mal
ay39
9.8
4.9
349
225
519
422.
16.
837
324
555
037
6.2
7.0
329
208
489
C
hine
se40
1.7
6.6
362
254
503
424.
29.
639
127
852
537
8.7
9.0
335
236
468
Ind
ian
377.
611
.434
222
950
640
2.2
17.5
360
250
518
354.
214
.532
321
647
5 O
rang
Asl
i PM
288.
257
.927
414
550
628
6.4
97.4
311
145
545
290.
346
.526
314
549
2 S
abah
Bum
iput
era
374.
311
.933
922
049
239
6.7
17.8
344
238
527
352.
915
.633
721
547
1 S
araw
ak B
umip
uter
a42
2.5
13.7
394
261
571
415.
719
.938
326
555
542
9.6
18.7
406
261
581
Oth
ers
Bum
iput
era
383.
622
.333
819
548
340
1.3
34.6
353
184
498
363.
424
.933
521
648
3Ed
ucat
iona
l Lev
el P
rim
ary
Scho
ol37
5.8
7.2
334
215
473
398.
19.
735
623
551
035
7.5
10.4
311
202
450
Low
er S
econ
dary
392.
97.
134
922
751
440
3.1
9.6
360
238
522
379.
110
.533
621
549
7 S
choo
l
Hig
her
Seco
ndar
y40
9.0
6.1
368
246
536
426.
39.
237
925
755
639
0.7
7.8
353
234
512
Sch
ool
Mat
ricu
latio
n/38
6.3
13.4
352
247
524
432.
719
.741
226
758
035
6.3
17.3
332
234
489
For
m 6
C
olle
ge/U
nive
rsiti
429.
410
.038
325
754
045
8.2
12.2
418
278
579
387.
616
.633
622
548
5 O
ther
s32
9.6
15.5
309
177
438
301.
231
.230
917
941
134
2.7
16.9
309
175
452
1 3MANS, Energy and Nutrient IntakesTa
ble
7. I
ron
inta
ke (
mg)
of
Mal
aysi
an a
dults
by
soci
o-de
mog
raph
ic c
hara
cter
istic
s an
d pe
rcen
t RN
I
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne10
.70.
29
613
12.0
0.3
97
149.
50.
18
612
Sou
ther
n10
.30.
39
612
11.6
0.6
97
138.
90.
28
611
C
entr
al10
.60.
29
612
11.6
0.3
97
139.
50.
28
611
Eas
t Coa
st10
.80.
39
613
11.6
0.6
106
1410
.00.
48
612
N
orth
ern
10.7
0.3
96
1311
.70.
49
713
9.8
0.3
86
12 S
abah
11.5
0.9
96
1313
.11.
89
614
9.7
0.4
86
12 S
araw
ak12
.00.
99
713
14.5
1.7
108
149.
30.
38
612
Stra
ta U
rban
11.0
0.2
96
1312
.40.
410
714
9.5
0.2
86
12 R
ural
10.4
0.2
96
1211
.20.
39
614
9.5
0.2
86
11A
ge G
roup
(yea
rs)
18-
199.
90.
58
613
11.1
0.8
96
1479
.38.
80.
58
512
30.3
20-
2911
.50.
49
613
12.8
0.7
107
1491
.410
.20.
38
612
35.3
30-
3911
.00.
29
613
12.0
0.3
107
1485
.79.
90.
28
612
34.1
40-
4910
.40.
38
612
11.8
0.5
97
1384
.38.
90.
28
611
30.7
50-
599.
80.
38
611
10.9
0.6
96
1377
.98.
70.
38
511
79.1
Ethn
ic G
roup
Mal
ay11
.00.
29
613
12.0
0.3
107
149.
90.
28
612
C
hine
se10
.70.
39
612
12.2
0.5
107
149.
30.
28
611
Ind
ian
9.1
0.3
86
119.
70.
58
612
8.5
0.4
85
11 O
rang
Asl
i PM
5.5
0.8
52
96.
31.
69
415
4.6
0.8
42
7 S
abah
Bum
iput
era
12.2
1.6
96
1415
.33.
39
615
9.2
0.5
86
12 S
araw
ak B
umip
uter
a11
.61.
59
612
13.9
2.8
96
139.
10.
48
612
Oth
ers
Bum
iput
era
9.4
0.6
86
129.
51.
18
513
9.4
0.7
86
10Ed
ucat
iona
l Lev
el P
rim
ary
Scho
ol9.
30.
28
611
10.0
0.3
86
128.
70.
28
610
Low
er S
econ
dary
10.6
0.2
96
1211
.60.
49
614
9.2
0.3
86
11 S
choo
1
Hig
her
Seco
ndar
y11
.30.
39
613
12.3
0.5
107
1410
.20.
29
613
Sch
ool
Mat
ricu
latio
n/10
.60.
69
613
12.4
1.2
107
159.
40.
68
512
For
m 6
C
olle
ge/U
nive
rsiti
12.6
0.7
107
1414
.11.
110
715
10.5
0.4
96
13 O
ther
s7.
90.
47
510
7.9
0.9
75
107.
90.
47
510
1 4 Mirnalini K et al.Ta
ble
8. V
itam
in C
int
ake
(mg)
of
Mal
aysi
an a
dults
by
soci
o-de
mog
raph
ic c
hara
cter
istic
s an
d pe
rcen
t RN
I
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne60
.61.
039
1783
60.0
1.4
3716
8161
.21.
441
1884
Sou
ther
n55
.91.
841
1878
53.4
2.6
3717
7358
.62.
542
1983
C
entr
al58
.11.
734
1576
56.7
2.2
3214
7359
.52.
635
1777
Eas
t Coa
st48
.11.
932
1560
48.7
2.7
3316
6147
.42.
832
1459
N
orth
ern
56.1
2.2
3716
8056
.53.
535
1580
55.7
2.7
3916
81 S
abah
75.1
3.8
4417
107
79.6
5.9
4315
103
70.3
4.4
4519
110
Sar
awak
94.5
4.5
7434
128
94.4
6.7
7435
134
94.6
5.9
7634
125
Stra
ta U
rban
60.0
1.3
3917
8259
.01.
837
1681
61.0
1.9
4118
83 R
ural
61.4
1.4
3817
8461
.52.
237
1682
61.3
1.9
4017
85A
ge G
roup
(yea
rs)
18-
1950
.03.
532
1469
55.9
5.8
3416
7479
.944
.03.
729
1368
62.9
20-
2958
.61.
837
1677
57.1
2.4
3615
7381
.660
.22.
738
1779
86.0
30-
3961
.71.
641
1884
57.9
2.3
3617
7982
.765
.52.
343
2089
93.6
40-
4963
.52.
140
1788
60.5
2.6
3715
8586
.466
.73.
243
1890
95.3
50-
5966
.42.
842
1988
72.8
4.2
4319
9310
4.0
59.6
3.6
4118
8285
.1Et
hnic
Gro
up M
alay
51.2
1.1
3315
6850
.51.
631
1465
52.0
1.6
3415
69
Chi
nese
77.1
2.3
5728
102
74.4
3.1
5727
103
79.8
3.4
5829
100
Ind
ian
44.5
2.4
2712
5746
.13.
925
1157
43.0
3.0
2814
57 O
rang
Asl
i PM
103.
019
.554
1616
790
.614
.572
2015
211
8.4
37.7
497
196
Sab
ah B
umip
uter
a75
.94.
548
1811
282
.67.
144
1511
269
.65.
553
2111
4 S
araw
ak B
umip
uter
a92
.55.
175
3013
193
.17.
669
2813
291
.86.
783
3313
1 O
ther
s Bu
mip
uter
a77
.810
.040
1593
87.3
15.7
3514
9166
.99.
241
1710
1Ed
ucat
iona
l Lev
el P
rim
ary
Scho
ol59
.91.
839
1784
60.3
2.6
4116
8759
.52.
538
1883
Low
er S
econ
dary
60.0
2.0
3816
8358
.32.
736
1582
62.4
3.1
4317
85 S
choo
l
Hig
her
Seco
ndar
y60
.21.
738
1882
61.1
2.6
3616
8059
.32.
140
1984
Sch
ool
Mat
ricu
latio
n/52
.82.
839
2078
51.3
4.7
3519
6653
.73.
442
2181
For
m 6
C
olle
ge/U
nive
rsiti
63.6
2.9
3918
8260
.93.
539
1979
67.5
4.9
3918
84 O
ther
s68
.85.
942
1493
68.0
7.9
3813
9869
.17.
845
1492
1 5MANS, Energy and Nutrient Intakes
Vitamin C intake of rural and urban adultswas similar but by zone, a difference ofalmost 43mg was recorded between thehighest (Sarawak) and the lowest (EastCoast). Among ethnic groups, Indiansshowed the lowest intake of vitamin C (45mg).By age group, vitamin C intake increased byabout 10mg from the 18-19 years group to42mg in the 50-59 years group. Increasingintake of vitamin C was observed withincreasing educational levels.
Vitamin A
Vitamin A intake of Malaysian adults wasaround 517μg (Table 9). By gender, it washigher in men (564μg) than in women(468μg). Intake of both men and womenexceeded the 75th percentile with RNIachievements ranging from 72-102%. Interms of strata, the rural adults’ intake (556μg)of vitamin A was higher than that of urbanadults (490μg). Sarawak had the highestintake of vitamin A (733μg) while Centralzone had the lowest intake (486μg). Ethnicgroup difference was observed where intakeranged from lowest in Orang Asli (196μg) tohighest in Bumiputra Sarawak (753μg). Byeducational groups Vitamin A intake waslowest in the Others group (486μg).
Thiamin
The mean thiamin intake of the respondentswas 0.8mg (Table 10). Men and women hadsimilar achievements of RNI across all agegroups. Similar intakes of thiamin were seenin all zones and by strata. The Orang Asliconsumed the least amount of thiamin(0.5mg) while the Chinese had the highest(0.9mg). A progressive increase in thiaminintake was noted with increasingeducational status.
Sodium
Malaysian adults’ mean intake of sodiumwas about 2575mg. By gender, Malaysianmen consumed about 500mg more thanwomen while intake was similar in rural andurban respondents. Sarawak and Sabahpopulations consumed the highest amountof sodium while the Southern zone had theleast intake. By ethnic group, Orang Aslihad the lowest intake of sodium (945mg)while the Sabah Bumiputra followed by theChinese had the highest intake. By agegroup, sodium intake ranged from thehighest in the 30-39 years group to the lowestin the 50-59 years group. A difference of 761mg in mean intake of sodium was noted fromhighest in the college/university group(2734mg) to lowest in the Others group(1973mg).
DISCUSSION
The reported energy intake of Malaysianadults from several sporadic surveys carriedout in various communities in the last 20years ranged from 1600 kcals to about 2300kcals (Chong et al., 1984, Zanariah et al., 1986,Chee et al., 1997). The MANS found a meanintake of energy that was lower than thevalues reported in these studies. Howeverthese studies, while being reference points,may not be comparable to the present studyas the dietary assessment methods used inthe latter were different, sample sizes wererelatively small and were not representativeof the total population.
Distinct differences in energy intakewere seen among geographic and socio-demographic characteristics. The intake ofenergy by Malaysian men was found to behigher than that of women by about 300 kcal.The estimates of mean energy intake
1 6 Mirnalini K et al.Ta
ble
9. V
itam
in A
inta
ke (
μg)
of
Mal
aysi
an a
dults
by
soci
o-de
mog
raph
ic c
hara
cter
istic
s an
d pe
rcen
t RN
I
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne51
6.5
9.0
379
211
639
563.
813
.641
924
670
046
7.5
11.8
345
190
580
Sou
ther
n45
4.2
12.2
358
218
612
498.
517
.841
226
368
140
7.1
16.4
318
189
543
C
entr
al48
6.3
14.2
348
200
577
537.
321
.138
522
164
443
2.8
18.7
321
177
517
Eas
t Coa
st53
5.8
29.6
378
206
648
597.
051
.943
425
368
947
1.2
25.9
338
184
613
N
orth
ern
523.
723
.241
523
166
755
7.6
26.9
445
275
719
491.
637
.337
420
061
3 S
abah
559.
034
.939
919
970
059
3.4
46.7
399
202
723
522.
651
.639
719
367
6 S
araw
ak73
2.7
49.6
498
276
870
785.
279
.154
530
690
067
7.9
59.2
465
239
820
Stra
ta U
rban
490.
111
.236
420
560
754
3.7
17.3
399
241
675
434.
614
.033
218
454
8 R
ural
555.
515
.040
021
868
659
3.3
21.9
438
253
729
516.
120
.435
619
562
9A
ge G
roup
(yea
rs)
18-
1942
0.4
26.1
335
168
572
478.
943
.438
620
368
179
.836
0.3
27.2
291
129
511
72.1
20-
2953
5.7
19.9
383
206
646
561.
527
.942
324
471
893
.650
8.8
28.5
350
188
583
101.
8 3
0-39
560.
618
.738
922
065
761
3.5
28.3
434
253
717
102.
350
6.6
24.2
358
204
616
101.
3 4
0-49
495.
914
.537
221
862
754
2.1
23.7
391
244
669
90.4
447.
516
.234
819
358
389
.5 5
0-59
494.
318
.737
921
361
957
2.0
30.6
431
254
689
95.3
412.
019
.331
617
556
082
.4Et
hnic
Gro
up M
alay
529.
713
.137
221
164
258
4.4
19.4
422
251
713
471.
417
.433
218
857
4
Chi
nese
487.
214
.439
622
662
352
6.3
20.8
438
254
679
447.
419
.835
820
157
2 I
ndia
n40
7.3
23.3
313
183
492
448.
742
.134
720
552
736
8.0
21.5
285
166
467
Ora
ng A
sli P
M19
6.2
58.9
184
046
621
0.4
102.
340
85
591
178.
753
.256
037
9 S
abah
Bum
iput
era
577.
950
.242
921
573
958
5.4
38.7
435
236
740
570.
890
.941
820
273
6 S
araw
ak B
umip
uter
a75
2.9
62.4
508
274
900
807.
010
9.8
508
287
900
696.
555
.950
926
392
2 O
ther
s Bu
mip
uter
a49
9.6
45.6
338
170
607
521.
568
.434
612
874
847
4.6
54.4
338
180
590
Educ
atio
nal L
evel
Pri
mar
y Sc
hool
493.
917
.436
720
760
956
9.2
32.8
413
253
684
432.
416
.332
918
656
5 L
ower
Sec
onda
ry51
4.3
16.8
393
210
660
539.
718
.243
423
771
347
9.6
30.7
353
192
602
Sch
ool
H
ighe
r Se
cond
ary
532.
516
.638
522
364
959
8.0
27.8
421
258
722
463.
517
.235
120
158
3 S
choo
l M
atri
cula
tion/
475.
133
.538
121
560
547
4.3
33.0
438
241
635
475.
750
.836
320
257
7 F
orm
6
Col
lege
/Uni
vers
iti53
7.5
27.5
380
204
654
566.
035
.341
724
569
549
6.1
44.4
331
175
573
Oth
ers
486.
048
.433
315
462
443
7.2
69.8
314
154
622
508.
762
.534
115
762
4
1 7MANS, Energy and Nutrient IntakesTa
ble
10. T
hiam
in i
ntak
e (μ
g) o
f M
alay
sian
adu
lts
by s
ocio
-dem
ogra
phic
cha
ract
eris
tics
and
perc
ent
RN
I
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
nM
ean
±SE
Med
ian
Perc
entil
esM
ean
2575
2575
%R
NI
2575
% R
NI
Mal
aysi
a Zo
ne0.
80.
00.
60.
41.
00.
90.
00.
70.
51.
00.
70.
00.
60.
40.
9 S
outh
ern
0.9
0.1
0.7
0.5
1.0
1.0
0.1
0.7
0.5
1.0
0.7
0.0
0.7
0.4
1.0
C
entr
al0.
80.
00.
70.
41.
00.
90.
00.
70.
51.
00.
80.
00.
60.
40.
9 E
ast C
oast
0.8
0.0
0.6
0.4
1.0
0.8
0.0
0.7
0.4
1.0
0.8
0.1
0.6
0.4
0.9
N
orth
ern
0.7
0.0
0.6
0.4
0.9
0.8
0.0
0.7
0.4
1.0
0.7
0.0
0.6
0.4
0.9
Sab
ah0.
70.
00.
60.
40.
80.
70.
00.
60.
40.
80.
70.
00.
60.
40.
8 S
araw
ak0.
80.
00.
70.
41.
10.
90.
10.
70.
51.
10.
80.
00.
60.
41.
0St
rata
Urb
an0.
80.
00.
70.
41.
00.
90.
00.
70.
51.
00.
80.
00.
60.
41.
0 R
ural
0.8
0.0
0.6
0.4
0.9
0.9
0.1
0.7
0.4
1.0
0.7
0.0
0.6
0.4
0.9
Age
Gro
up (y
ears
) 1
8-19
0.7
0.0
0.6
0.3
1.0
0.8
0.1
0.7
0.4
1.0
66.7
0.7
0.1
0.6
0.3
0.9
63.6
20-
290.
80.
00.
60.
41.
00.
90.
10.
70.
51.
075
.00.
80.
00.
60.
40.
972
.7 3
0-39
0.8
0.0
0.7
0.4
1.0
0.9
0.1
0.7
0.5
1.0
75.0
0.8
0.0
0.6
0.4
1.0
72.7
40-
490.
80.
00.
70.
40.
90.
80.
00.
70.
51.
066
.70.
80.
10.
60.
40.
972
.7 5
0-59
0.8
0.0
0.6
0.4
1.0
0.8
0.0
0.7
0.5
1.0
66.7
0.7
0.0
0.6
0.4
0.9
63.6
Ethn
ic G
roup
Mal
ay0.
80.
00.
60.
40.
90.
80.
00.
70.
51.
00.
70.
00.
60.
40.
9
Chi
nese
0.9
0.0
0.7
0.5
1.1
1.0
0.0
0.8
0.5
1.2
0.8
0.0
0.7
0.4
1.1
Ind
ian
0.8
0.0
0.7
0.5
1.0
0.9
0.1
0.7
0.5
1.0
0.7
0.0
0.7
0.4
0.9
Ora
ng A
sli P
M0.
50.
10.
50.
20.
90.
50.
20.
50.
21.
00.
50.
10.
40.
10.
9 S
abah
Bum
iput
era
0.7
0.0
0.6
0.4
0.8
0.8
0.0
0.6
0.5
0.8
0.6
0.0
0.6
0.4
0.8
Sar
awak
Bum
iput
era
0.8
0.0
0.6
0.4
1.0
0.8
0.0
0.7
0.4
1.0
0.8
0.0
0.6
0.4
1.0
Oth
ers
Bum
iput
era
0.6
0.0
0.6
0.4
0.8
0.6
0.0
0.5
0.4
0.8
0.6
0.0
0.6
0.4
0.8
Educ
atio
nal L
evel
Pri
mar
y Sc
hool
0.7
0.0
0.6
0.4
0.9
0.8
0.0
0.6
0.4
0.9
0.7
0.1
0.6
0.4
0.9
Low
er S
econ
dary
0.8
0.0
0.6
0.4
1.0
0.9
0.1
0.7
0.4
1.0
0.7
0.0
0.6
0.4
1.0
Sch
ool
H
ighe
r Se
cond
ary
0.8
0.0
0.7
0.5
1.0
0.9
0.1
0.7
0.5
1.0
0.7
0.0
0.6
0.4
1.0
Sch
ool
M
atri
cula
tion/
Form
60.
90.
10.
70.
51.
00.
80.
00.
80.
51.
10.
90.
10.
60.
41.
0
Col
lege
/Uni
vers
iti0.
80.
00.
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51.
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90.
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9 O
ther
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50.
30.
80.
60.
10.
50.
30.
80.
60.
00.
50.
30.
8
1 8 Mirnalini K et al.
reported here for men and women are belowthe recommended intakes for Malaysianadults. The differences observed betweenreported and average recommendations maybe due to under-reporting of food intake bysome subjects and/or may reflect lower levelsof activity in the population. The higherenergy intake in men compared with womenis to be expected and can be attributed to thehigher proportion of lean body mass in menwho may also be more physically active. Itcould also be due to the fact that women tendto under-report their food intake (Pryer etal.,1997). However, when strata was takeninto consideration, gender differencedisappears which then concurs with thestudy of Chee et al. (1997) that men andwomen in rural and urban areas were notdifferent in their energy intakes.
The decline in energy intake with ageis compatible with the reduction in energyrequirement with aging, a consequence ofreduction in basal metabolic rate due to theloss of fat-free mass and a possible reductionin physical activity. By ethnic group, theOrang Asli community had the lowest intakeof energy, a finding that reflects the poorsocio-economic status of this community.There appears to be no improvement inenergy intake by the Orang Asli communityfrom that reported by Khor (1988) and Ismail,Wong & Zawiah (1988) on Orang Asli Semaipopulation. The Bumiputra Sabah andSarawak appear to consume the largestamount of energy. However comparablestudies are not available. Lower averageenergy intakes were reported for Malay andIndian women estate workers (1538 kcal)and urban office workers (1527 kcal) (Cheeet al., 1996; Fatimah et al., 1996). A recentstudy on the dietary intake of women in ruralareas of Selangor found mean energy intakesranging from 1550 to 1581 kcal (Zalilah &Khor, 2005).
Percentage of energy from macro-nutrients
The proportion of energy derived from macro-nutrients has been used to assess the qualityof diet and distribution of macro-nutrientintake of individuals (Mattison et al., 2001).In this survey, the relative contribution ofmacro-nutrients to the total energy intake ofrespondents by all demographic charac-teristics were well within dietary guidelinesfor a healthy diet and met the populationnutrient goals recommended by WHO(2003). However, in comparison to the studyby Chee et al. (1997), Malaysian adults ingeneral appear to have increased their fatderived energy intake from 23 to 27% (+4%)while energy intake from carbohydratedecreased during the same period from 63to 59%. Energy contribution from proteinintake, however, has remained unchanged.
Differences in the proportion of energyfrom macro-nutrients particularly fromcarbohydrate and fat were observed amongethnic groups. The highest proportion ofenergy from carbohydrate was seen in theOrang Asli (70%) while the lowest was inthe Chinese community (55%). Fat percentenergy in the Chinese was twice (30%) thatof the Indian group which could be due thedifferences in cooking methods.
The distribution of energy from macr-nutrients in the diets of Malaysians as foundin this study is also comparable to that ofSingaporeans (carbohydrate: 55%, protein:15%, fat: 30%) and the Hong Kong Chinese(carbohydrate: 53%, protein 18%, fat: 29%)but proportionately less carbohydrate andmore fat than the Japanese (carbohydrate:59%, protein: 25%, fat: 16%) (25). Incomparison to their Western counterparts,however, Malaysians consume propor-tionately more carbohydrate but less fatcompared to the British (carbohydrate: 45%,protein: 16%, fat: 39%), Australians
1 9MANS, Energy and Nutrient IntakesTa
ble
11. S
odiu
m i
ntak
e (μ
g) o
f M
alay
sian
adu
lts b
y so
cio-
dem
ogra
phic
cha
ract
eris
tics
Cha
ract
eris
tics
All
(N=6
886)
Men
(n=
3327
)W
omen
(n=
3559
)
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
Mea
n±S
EM
edia
nPe
rcen
tiles
2575
2575
2575
Mal
aysi
a Zo
ne25
7523
.022
9314
7633
8328
1934
.425
8417
1036
7523
2229
.220
7213
1731
06 S
outh
ern
2425
50.0
2172
1437
3188
2697
81.2
2454
1639
3499
2136
50.1
1971
1289
2778
C
entr
al25
2538
.121
9114
4232
3727
8255
.024
6917
0636
0322
5450
.019
6512
3330
06 E
ast C
oast
2706
68.3
2472
1542
3509
2854
103.
127
0517
5736
4825
5089
.422
4214
2733
60
Nor
ther
n24
8053
.122
2914
4032
0226
8275
.424
6716
7834
1622
8972
.719
6813
1530
77 S
abah
2923
99.0
2533
1495
3788
3072
137.
627
4316
4639
2227
6614
4.7
2364
1396
3719
Sar
awak
2831
75.1
2585
1653
3773
3219
119.
230
3919
7142
5224
2783
.322
3214
7832
39St
rata
Urb
an26
0131
.523
2114
8533
8328
4746
.825
8517
2436
9623
4640
.220
9513
3031
11 R
ural
2538
33.1
2283
1461
3382
2778
50.6
2578
1702
3648
2286
41.6
2053
1315
3101
Age
Gro
up (y
ears
) 1
8-19
2494
116.
422
6614
5433
8527
9319
7.3
2708
1640
3777
2186
114.
320
3612
4430
76 2
0-29
2645
40.1
2363
1532
3446
2844
52.1
2616
1775
3699
2438
60.2
2165
1345
3239
30-
3926
7139
.323
7615
2434
5429
3759
.927
0217
4438
5423
9948
.821
4014
0331
67 4
0-49
2500
42.4
2249
1407
3257
2765
61.0
2545
1657
3577
2222
56.1
1973
1250
2942
50-
5924
1459
.021
3113
5732
5426
4587
.823
2215
2935
1821
6975
.418
5012
2929
52Et
hnic
Gro
up M
alay
2507
30.0
2251
1457
3304
2749
45.4
2494
1670
3537
2249
36.5
2030
1315
3068
C
hine
se29
1649
.026
6818
0837
3331
8967
.929
3620
8941
5826
3869
.023
4215
8133
55 I
ndia
n19
6561
.917
2511
0124
8621
3796
.119
4012
3227
6318
0177
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9210
0921
93 O
rang
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i PM
945
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875
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933
535.
711
3929
2572
959
342.
275
237
1156
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ah B
umip
uter
a29
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7.8
2594
1554
3787
3328
167.
930
1817
6140
1625
4811
8.8
2365
1364
3648
Sar
awak
Bum
iput
era
2707
96.1
2395
1495
3566
2891
140.
328
5216
5139
6725
1512
6.0
2115
1426
3187
Oth
ers
Bum
iput
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2518
179.
822
6812
9732
7126
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1.9
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721
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02Ed
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iona
l Lev
el P
rim
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ower
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ry S
choo
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7064
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8616
5736
5723
4266
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2312
6331
26 H
ighe
r Se
cond
ary
Scho
ol26
6339
.223
7115
8934
7728
9356
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02
Mat
ricu
latio
n/Fo
rm 6
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3997
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120.
820
8813
0533
65
Col
lege
/Uni
vers
iti27
3470
.125
2916
6234
1629
6410
1.5
2732
1874
3702
2400
86.3
2246
1446
3086
Oth
ers
1973
98.4
1778
1155
2693
1900
228.
918
6310
2530
3020
0895
.217
6311
7126
19
2 0 Mirnalini K et al.
(carbohydrate: 45%, protein: 17%, fat: 32%)and New Zealanders (Russell et al., 1999).
Intake of micro-nutrients
Iron intake as a percentage of RNI inMalaysian women was below 50% and fellto as low as 30% in the youngest age group.Various studies in the country have reportedthat iron deficiency and anemia continue tobe significant problems. Tee et al. (1998)documented that 25% of women aged 18 to<60 years in rural areas and estates hadanemia while a survey in remotecommunities in Sarawak found a highprevalence of anemia in men >40 years andin young women. However, true irondeficiency cannot be ascertained fromdietary intake alone as individuals generallyadapt to poor dietary intake by increasingtheir rate of absorption and by using bodystores to maintain equilibrium whileindividual rates of absorption and lossesmay differ greatly from predicted values(Hallberg & Hulthen, 2000). Thus, true ironstatus as determined by biochemicalmeasures is necessary to determine the extentof prevalence of deficiency.
Calcium intake in both men and womenacross socio-demographic groups did notmeet the recommended intake. Low calciumintake poses a public health concern as it isincreasingly recognised that inadequatecalcium intake during the pre-menopausalyears reduces bone density and increasesrisk of osteoporosis after menopause (Heany,2000). Low calcium intake has also beenimplicated as a risk factor for colorectalcancer and hypertension (Wu et al., 2002),the incidence of which is increasing in theMalaysian population.
Chronic inadequacy of thiamin in theearly part of the 20th century led to beri-beriin migrant workers in tin mines and estates.Today, this nutritional deficiency has been
practically eliminated. Yet this study foundMalaysian adults’ intake of thiamin to bebelow the recommended intake. Thegenerally low intake of this vitamin couldbe due to the lower energy intakes reportedhere.
Sodium intake has been consistentlyassociated with blood pressure which is amajor risk factor for coronary heart diseaseand stroke (WHO, 2003). An estimatedsodium intake >2300 mg has been shown tobe significantly related to the slope of bloodpressure increase with increasing age(INTERSALT Cooperative ResearchGroup,1988). The mean intake of sodiumwas higher in men than women by about500mg while its consumption declined withage. Although rural-urban differences insodium intake were not obvious, it wasfound to be highest in the group with thehighest educational level and in the Chinese.Culturally, the latter group is well knownfor its excessive use of soy based sauceswhich are noted to be high in sodium. It isrecommended that dietary intake of sodium,from all sources should be limited so as toreduce the risk of coronary heart disease andstroke (Sacks et al., 2001).
Comparison of intakes of othermicronutrients such as vitamin A, vitaminC and thiamine with RNI were all found tobe less than adequate in all age groups inboth men and women. With lower energyintake, the intake of many micro-nutrientswill be expected to decrease. Hence the lowerintake of all these nutrients particularly inwomen and with increasing age (with theexception of vitamin C).
Strengths and limitations of the study
The strength of this study is the largerepresentative sample of the Malaysian adultpopulation from a wide range of socio-demographic backgrounds. The main
2 1MANS, Energy and Nutrient Intakes
limitation of our study is the use of a single24-hour recall. Multiple 24-hour recallswould have provided better estimates ofintake, but would have also increasedrespondent burden, which in turn may havecontributed to decreased participation in thisstudy not withstanding the cost that it mayhave incurred. A limitation that cannot beoverlooked in self-reported dietary intakesis that food and nutrient intakes are oftenunder-estimated. Black & Cole (2001)estimated under-reporting in dietaryassessment methods to be 64%, 88% and25% of the results using diet records, dietrecall and diet history, respectively. Yet, thisstudy utilised well-trained nutritionists andthe interactive approach in which repeatedand skillful probing was done to help therespondents recall as accurately as possibleall food and fluids consumed. Even so, ahigh degree of under-reporting was foundin this survey. Low energy reporters,however, were not excluded from the presentanalysis as exclusion would have biased thedata towards higher intakes. Nonetheless,actual energy intake and hence nutrientintakes are likely to be under-estimated.
CONCLUSION
Acknowledging the caveats of under-reporting and limitations of the dietarymethod used, the MANS provides uniquenew data on the energy and selected nutrientintakes of the Malaysian adult population.The study found an intake of energy thatfalls short of the recommended intake in bothmen and women, although intake of macro-nutrients met the recommendations for ahealthy diet. Intakes of micro-nutrientsstudied were below the RNI with calciumand iron being the most inadequate,particularly in women. Regular nutritionsurveys should be carried out to providevaluable information on trends in food and
nutrient intake, particularly among age andethnically diverse subgroups of thepopulation. Future studies are needed toexplore the associations between diet andchronic diseases among Malaysians andfinally, continued nutrition monitoring isneeded to assess public adherence to dietaryrecommendations.
ACKNOWLEDGEMENTS
The authors would like to extend theirgrateful thanks to the Director-General of theMinistry of Health for permission to publishthis paper. The support given by therespective state nutrition officers, researchofficers, data enumerators and many otherswho helped throughout the study is alsogratefully acknowledged.
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