SPECIFIC NUTRIENT DEFICIENCIES IN MALAYSIA - NutriScene

SPECIFIC NUTRIENT DEFICIENCIES IN MALAYSIA

E-Siong Tee

Division of Human Nutrition Institute for Medical Research 50588 Kuala Lumpur Malaysia

ABSTRACT

The rapid -ncio-economic development ancl parallel improved health CHe in 1alasia has brnugh ahout

Improved health and nutrition situation in the country While the overall nLJtriillil situatiun hiS Irshy

iOllS studies carried out have shown that pockets of malnutrition exist amung JriuLJS rural and u-ral under-

communities Overt nutritional deficiencies have rarely heen cnc)unlered but mild-to [1])dcralc

undernutrition affects significant proportions of the population rhe Il1Jjor nutrient deficiencies in the Cllunshy

tr) arc protein and energy malnutrition iron deficiency anltmi2 vitamin r

Groth rctarJalion ha been reported to occur among rural preschool anJ schunl-age children The prevashy

lence of acute undernutrition (wasted) and severe chronic undernutrition (Iastcd 3nd~lunted) is 1) hUI

c()nsiderahle amount of chronic undernutrition (stunted) and undrvicight art knuwn tl exist Iron

anemia remains j of considerable magnitude afflicting mainly women of chi age and

yOiJng childrcn Vitamin A deficiency does not appear to pose a serious prohlem in tht comlry Cioire ha-shy

been found tn affect selected communities in Ihe interior parts cf PeninslIla c whi the prollt1l11l is

knuwn 10 he of J cnnsiderable magnitude in Sarawak The perlstcncc of these nutrient Jdicienes in the

country clearly indicate the need for the implementation of appropriate intervention prngramme and the

continuous monitoring of the nutrition situation

1 Introduction

Concern Im the nutritional status of an individushy

al or cOll1munity sterns from the fact that nutritionshy

al deficiencies can result in such deleteriuus

c flects depressed physical and mental

menl reduced resistance to infections greater risk

tn premature delivery increased maternal and

todal mortality and morbidity and reduced ork

performance Thest consequences of malnutrition

waste human resources and add to the social costs

ulthe nation Therefore It is imperative for nutrishy

tionists to work closely with policy makers in

ldentiling nutritinnal prohlcrns that may exist so

110

that tilncl) intercl~I)ll clluld he impielllenlfd

In a rcport In this Seminar the Dverall

nutriticn situation in IIalaysia has been hC1 n to

Jver the years (Tee 19(1)

However as can be expected owing to tIle L rIven

distrJhLltion of facilitits and rCSOL rces P)dCIS of

malnulrilinn exisl in various parts of the country

This piper the major nutrient deficienshy

cies encountered hy various cbullmmlunities prticushy

larl) thc ilegccl rural and urban cl)nJn1Unishy

tics Data Cited in this paper have been cerived

from n Jtrition studies arried cut hy various Insitllshy

lions in the tmiddotulHllry

1

I

I

1 I I

Figure 1 Weightmiddotfor-Age of Malay Pre-School Children Peninsular Malaysia (sexHS combined)

20 ---------------------------- NeBS median

13

i6

25 45 55

(WHO 1983) --1l- shy

Upper income (McKay ct aI 1971)

-- -_

~~~~~) bullbullbullbullbulllt)bullbullbullbullbull

Rural villages (Chong Cl aL 1984)

- Aborigines

(Khor 1985)

-----shyRuralillages

(Chollg CL al 1972) -a--

Ag (yur)

2 Protein-Energy Malnutdtion

Sume recent data (Chen 1983 Chong lt aI

19S4 Khor 14S5) on groWl h perfnrmance nf preshy

~ch(lul chiluren d sh(wn in Figurl 1 Thc~e

~ eight-lor-age (bta were plotted S(lnle

data collected in tne 1 enOs (McKay et 31 1471

Chung et aL 1472) and the NCHS median (WHO

1 4S3) A general trend in growth performance II

these childnn may te seen and some ot th

i ncl ude

bull upper income children had better

age achievemnt than tnose from rural areas

bull an apparent gCiin in weight-for-age amnrg lhc

uf poor rural communities u cr

a decade period

bull there seemed to be less gain In

for the upper income group (for hich rlashy

tively less data arc available) after more than

a decad

bull the group 01 ao()rigine children studieu In Ille

mid-19HOs dpparcd tn be worse ()f thun the

Figue 2 Height-for-Age of Malay Pre-School Children Peninsular IIJ1aiaysia combined)

IW --------------------------------

Isexes

NCHSme4iau (HO1983) --tI- shy

Up~r income

liD ~~191Ii

100 I R=7~es(Cbong et aI 9S4) -b--shy

I Aboriginesj - i~) E 90shy

~ If I ~ ~

~ J01-fI

60 J__ ~----~-------- shy

05 15 35

Ige (years)

Sowc Ttl amp Klwr (1986

ural poor bld Ihildren

Th data or tl-e-c groups of chil shy

dren were Similarly plHICd tlnd -hown n

It iar he secn lhll

achievCIllLfll of the upper

llCllfllC chlldem hich ~lemd to Iprroxishy

nate the Nelf S meJ ian was cca rll better

Itlthan that (if he rural children

bull tlcre 1 1 Simi ar improviment in

lge lCf the laq decade anwng the rural preshy

choolhlluren

When ex n terms (1 -height

(FigUf ~)

bull the ru ral preschoolers shJwcd achicyclllcnh

It CJ2middotlJWr or the NeHS relercnc( middotn1H rrl

t -~--w a dnadc

bull thre as a ckar trend fer lhe upper income

I-hildrcn they possessed cightfumiddot-hcight

lchievcmtnls that range htlween X7 lO 95(1

~I ttl NCHS rl ennce

-----Ill

Figure 3 Weight-far-Height of Malay Pre-School Children Peninsular rl1alaysia

(sexes combined)

100

95

~ 13 E

CI)c u 90Z 0 laquo ~

p

85

Upper iJcom( (McKay et al 1971)

---+-shy

Upper incom( (Chen 1983)

--oooG-shy

A bullbullbulllgt

Rural village~~gt~~ (CtlOng et ai 19~4)

bullbullbullbullbullbbullbullbullbulle-- Rural village

(Chong et al 1972)rmiddot----~_ --- - -pound)-shy -shy

--1]

~

80 -------- shy05 25 35 45 55

Age (years)

Source Tee amp Khor (1986)

Figure 4 PrevalenCE of Growttl Retardation in Primary SCllOOI Childrln of Rural Villages

Peninsular Malaysia

60 ~------middot---------------------------------------middot---~8~s~~

4950

40 38

Boy~ (0=4lt0) Girls (0=501)

Source Chong (1 al (J93f)

III -- shy

~was~

II Was~ amp Stunted

lli~ UodexweJgtu

1 I

Figure 5 Comparative Growth Achievement of (a) Primary School Boys ald (b) Primary School

Girls in Selected Rural Villages and Urban

BOYS

k 40

U

u

(a)

(JJ(m til performance ~lr primary school children

11a alsu heen gien considerable attention hy

[1 Some recent data from rural children

n Peninsular Malaysia et at 19X4) are givshy

[1 In Figure + The prevalence of acute malnutrishy

111m (astcd) and snere chronic undernutritIon

t ~asted and stunted) were minimal but considershy

Jble amount 01 chronic undernutrition (stunted) md

uIHkfveight ere seen Compared to their urhan

lluntnparts the median weight and height curves

)1 these children Were ckarly inferior to their urhan

_uunterparts in Kuala Lumpur and PetaJing Jaya

I FJgure 5) Such differences in growth achieve

Ilent of rUIal and urban school children have ~ISll

hlen reported earl ier 1977

Scveral studies havt hten undertaken tu quantitak

InuJ consumptiun of c)[1l111unitics e~nphasisil1g parshy

pmtelpoundl and ellergy intake Examples of

rccent large scale studies inClude the househuld

loud consumption of 1+ rur31 villages in Peninsular

Areas SourceChong et al (1984)

GIRLS AGE (YEAI=tS) 9 to 11

L6---7----8----9---1O--~--~21

AGE (YLARS)

(Chung ci 31 Iq~4) and ~tudies on fve

(unlmunlties in S3hah Chen et 31 19R1) Ir the

fnrnler ~udv the that 66 ut

the hou-h()lds were Ill) able tll meet their rcquireshy

[IHnt lur Ltorie lnd ql( ur households 1heir

nLjuireI1~en1 tor prckir Similarly for thc Sahah

-tUlh there ltlS a idl range ur nutrient conslJlllpshy

lioIl and I(lr 3 ur the ~t1mmunitils some 7S( 01

the hlllheh)lds had a ITedian calorie intJke thai

vere below their In the case 01 pro-

kin it as t~lund that HJ-30r( of the huuseholds

OIU nut meet requinIllerll

Se lTtI recellt studiei on food cunsumptiln by

IndillILJ~lI 11Ousctll)ld members havc been

1lle~ed h TlC and K lOT (1l)S6) In general proshy

lein Intake hy aduILsctnts and preschool children

Ippcarcd te Iw JdcqUltlIC As has been round fll[

ItllUSlhold lood data adequacr Ior

allrie had been oh~cn cd IU be a greater

lh~lll pn[lill

113

1

Table 1 PrevalencE~ of Anemia Amongst Children of Various CommunitiEs 1

Peninsular Malaysia a rural villages 33

number of children 512 910

iChongetal198-1)

Sarawak a rierinc Iban 44t 26

1umbcr of chtldrcn 107 1082

IAndcrson 197619771

h Inland Penan 45

number of children 123 (6mths 8ys)

Anderson1978b)

Sabah a Interior West Coast amp Kudat 20-31 16-31 (f

number of chi Idren (total n 3672)

(Chen et aI 1981)

b Bengkoka Peni nsula 44q~ (O-72mths)

number of children (Iota n 90)

(Kandiah et aI 1

1based on the following haemoglobi 1 concentration cut-off levels

lt6 years lt 11

6-12 years lt12 gldl

3 Anemia

Besides poor growth achievement cnother major

nutritional problem in Malaysia is iron deficiency

anemia which has been investigated for some

years in the country (Tee 1985) Some selected

data Chong et al 1984 Anderson 1976 1977

1ll78a 1978b Chen et aI 1981 Klndiah et aI

19S-1) amongst children of various population

grlHjp~ studied in the late 1970s and early 80s

arc shown in Table 1 It can he seen hat the probshy

lem is of a considemble magnitude including

amongst children in the Peninsula with prevashy

lence rates ranging from 16 to 4Y)L

lf

The anemia prohlen allUngst pregnant Vvonen

has also received particular attenticn Like the

growing children these W(lrnen are at particular

risk to the develupment of anemia due to increased

requirements In a recenl study (Tee et aI 1(84)

concluded at the 1alernity Hospital Kuala

Lumpur a moderatel high prevalence of anemia

amongst J group or pr2gnant women or lower

socio-econemic status was reported (Table 2)

Anemia i1 the studv was said to be

related mostly to iron and to a lesser extent foate

deficiency

Table 2 Nutritional Anemia Amongst Pregnant Women in the Maternall Hospital Kuala Lumpur

Elhnic

Paramelers Chinese Malays Indians Combined

Hemoglobin n mean SO I) lt 11 gldl

Packed Cell Volume n mean SO (0()

lt 33ltf(

Serum Iron n mean plusmn~ SD ()

1( lt 50 u gJI

Transferrin Saturation

mean SO ((Ir )

(~lt 157r

Ferritin r mean SO (r)

(l lt 12 ngldl

Serum Folate n mean SO (r( )

median

lt3

Serum Protein n mean - SD (ir)

lt 6 gdl

Serum Albumin n mean SD (if)

lt 3 gldl

104 lAx 180

308

104 603 458

240

117 6ll 18 plusmn 3507

453

117 1945 991

3R5

110 21 86 plusmn 2534

409

104 470 plusmn 506

315

452

117 603 035

365

117 324 024

111

109 1115 151

477

109 3475 450

312

L~1 4845 j 3353

603

121 1587 844

512

103 1109 880

612

101 330 plusmn 383

240 663

121 621 043

231

121 311 032

256

63 1051 middotiI1R

587

63 3367 ~42

476

71 4738 3~8-

()q()

71 1523 H39

549

67 1261 1532

627

66 247 244

160 773

71 613 06

254

71 29lt1 O()

465

D6 1113 17()

-U8

~76

3499 - 460 j I_J __

09 5265 t IU-ltJ

566

3U9 1708 921

472

2~(I

1569 1902

536

271 364= -Ll9

240

60L)

JOL) 612 039

2-S

3U4 31 J 1J30

24Q

S1Urcclcc c at (1984)

L 5

4 Vitamin A Deficiency Studies carried out in several poverty villages in

Peninsular Malaysia have indicated that vitamin A

deficiency does not appear to pose a serious probshylem in the communities studied (Chong et aI

1(84) Clinical signs of xerophthalmia were rarely

encountered Eye signs that could be associated

with vitamin A deficiency were dryness and wrinshy

kling of the conjunctiva observed in some 10 of

the schoo children Data on serum vitamin A stashy

tus obtained for a smal number of children

showed that there was a I)w prevalence of low levshy

els of the vitamin (Table 3) There was a problem

of obtaining sufficient blood from the children tor

biochemical analysis Among the adu Its (16-45

from whom it was to obtain

enough blood from a larger numner of ~U_L~

the results indicated with more certainty that v itashy

min A deficiency did not appear to constituk a

serious problem in tht communities studied

In a reCient thorough reVliew of th~ literature Tee (1988) rtportcd that th e vitamin A deficiency

problem appeared 10 be confined to ccrtJin

groups m ainlyin the rura areas and did not p~e

a major 1eallh hazard 1ationwide The pronkm

also appeared to haVe lessened over the years It

was however noted tha there are many remnte

areas in tle country whert the vitamin A statu

not known including among urnan squatter ar(1-

It was PO nted that the lac of comprehensie d 3la

should not be taken as indicative 01 absence l)[ he

problem Extensive mapping of the vitamin A stashy

tus of chldren in the cOLntry remains an imF~lrshy

tant task

Table 3 Serum Vitamin A Levels in Rural Villages Peninsular Malaysia

groups Mean plusmn SD c( with low

(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353

Men 46 years and above

n = 14

Women 46 years and above

n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I

Source Chong et al (19S4)

116

1

5 Iodine Deficiency

Endemic goitre too does not appear to be a major

nutritional problem in Peninsular Malaysia except

for a few studies which have indicated high prevashy

lence rates in isolated parts of the Peninsula The

problem is however much more extensive in

Sarawak A recent rcvic (Tan 19R2) indicated

that 12 of the States 25 districts have heen identi shy

fied as goitrous with vary ing rates (I prevakncc

Table 4 Summary of Goitre Studies in Sarawak

and ocurring mainly In the inland areas (Table 4)

It h2S heen estimated that there were at kast 20 000 cases of endemic goitre in Sarawak representshy

ing about 15 of its total population The prohmiddotmiddot

lem is said to be caused primarily by iodine defi shy

ciency in the diet and goitrogens probably

small and unimportlttnt role in most ~)r Sarawak

(Chen 1(81)

Location Ethnic groups Age (years) Total Prevalence

First division Chi nese t1alay 10-14 ([COllie) 213 49R

nidu) ah gt 15 (rennie) 157 522 Second division Ihan Malay 10-14 (fennle) 14~ 3~~

Chinese gt 15 (fe m11 e ) 161 KO7 Third sixth and seventh Ihan Chinese 10-14 (female) 252 345

divisions 1alay Kejaman gt 15 (female) 589 552 Fifth division Mala ~ Chinese 10-14 (female) 20 middot+50

than gt 15 (female I 151 450 Total gt I 0 (fe III a Ie) 175( i(J()

gt 15 (female) I05~ ixn Third division Ihan All ages 60S X (l11a i )

Rejang River (interim) (buth sxes) 33( female) Second division Ihan gt 11 (both sexes) 16 995

Lubuk Antu (interior) Ruba (coastal) Ihan gt II (hath sexes) 38 7-1-1 Bajong (coastal) Ihan gt 11 (both sexes) 122 3U Second division than is (buth sexes) 388 765

Lemanak River (Interior) mothers only 16() qUS

Fourth division KJaniKel1val1 lt 7 (bOlh sexes) 556 JO-l Middle Baylt1Il1 middot~middotK (both sexes) 37~ 551 (intermediate) mothers only 14~ uO

Muda area (intrinr) PJnan All ages (rolllJdic trihe) (both sexes) B-1- 5l)3

Seventh division Iran lt 7 (both sexes) ~ 14 11l

SutMujong River mothers only 106 ~()2

(interior) Second divisiun Illtn gt 15 (female) 75 (133

Upper Ltl1lanak Ri cr 8 12 (both sexes) 152 1

(interior) Third division Il~an gt 15 (female) 137 1~ 7

Kanowit District (Rejang River interl(ll Kanowit Tovv n IbltJn Chinese 7-12 (hoth sexes) 54 (I

Fourth divisioll K nan Kenyah 10-14 (lcrnale) 11(1 7XO

Tinjar River Iban gt 15 (lcmale) i57

10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions

Available data show that nutritional status of

Malaysians has been improving ever the years

Frank nutritional deficiencies are rarely encounshy

tered Nevertheless mild to moderate malnutrition

exists amongst various population groups espeshy

cially the vulnerable groups in socio-economically

disadvantaged communities Growth retardation

and anemia are the maior problems encountered

while vitamin A deficiency and iodine deficiency

goitre are prevalent among selecled population

groups A variety o~ intervention programmes

have been implemented to ameliorate these

problems and would n(~ed further intensificatiun

to achieve the targeted objectives

ACKNOWLEDGEMENT

I thank Dr M Jegathesan Director uf the Instishy

tute for Medical Research tor ~uppmting my parshy

ticipation in this Seminar and th Ministry of Health Malaysia for granting me permission to

present this paper and attend the Sen- inar

References

1 Anderson AJ U

Nutrition of Ihan children ot niddle Mukah

River Report of tile Sarawak Medical Sershy

vices 1976

2 Anderson AJU

Nutrition of tban children of the Sarawak

River Delta Report 01 the Sarawak Medical Services 1977

3 Anderson AJU

Nutrition of Iban children of the Sut and

Mujong Rivers Repun uf the Sarawak Medical

Services 1978a

4 Anderson AJU

Subsistence of Ihe PInan in the Mulu area of

Sarawak Report of the Saravak Medical Sershyvices 1978b

5 Chen PcY

A preventahle and yet highly prevalent disshy

ease in Sarawak Endemic gOItre 3667-691981

6 Cher Pc Y Chan MKC Teoh ST Bent

8 Yap S8 Fong T Ong FPT Lee

MCC

A nutrition study of the Interior West oast

and Kudat Division of Sabah 1981

7 Chen ST

The assessment of physical growth and

development frcm birth to 2 years of (lge in a

selected group of Malay children from higher

income families MD Thesis 1983

8 Chong YH McKay DA Lim RKH

Some results Jf recent nutritiDn SUfcys in

West Malaysia Iwith emphasis on nutritimal

anthropometry and biochemistry) Bull Puh

Hlth Soc 655middot611972

9 Chong YH Tee ES Ng T KW KandJh

M R Hanis Hus~ein Teo PH Siti 1

Shahid Status of community nutrition in poverty

kampungs Bullelin flO 22 1984

10 Kancliah M L(e M Ng TKW Ctlong

YH Malnutrition ic malaria endemic illages ~)f

Bengkoka Peninsula J Trop Pacd lO 23shy

291984

11 Khor G L A study on tne nutritional status (It the

Semai PhDTh4~sis 1985

12 McKay DA Lim RKH -lotaney KH

Dugdale AE

Nutritional assessment hy cumparative

growth achievement in Malay children hehm

school age Bull World Hlth 45 2)3middot=42

1971

13 Rampal L Nutritional status of primaly schoul chilshy

dren a comparative rural and urban -tudy

Med rMalaysia 32(1)6-16IQ77

118

14 Ravi T

Assessment of nutritional status of children

in an estate by means of anthropometry and

dietary study BS (Human Development) Disshy

sertation 1984

15 Tan YK Endemic goitre in the State of Sarawak

Malaysia In Proceedings of the Workshop

on Cassava Toxicity and Thyroid Research and Public Heallth Issues 31 May - 2 June66shy

681982

16 Tee ES

Spectrum and Perspectives with Relevance

to Malaysia National Population and Family Development Board Nutritional Anemias 1985

17 Tee ES

Carotenoids and Retinoids in Human Nutrishytion Institute for Medical Research 1988

18 Tee ES

NUlrition in a rapidly-developing economy shy

Malaysia Paper presented at the Seminar on

Nutrition in Health and Disease 16-18 October

1991

19 Tee ES Kandial1 M Jaafar Al i Kandishyah V Mohd Rusli Zahari Kuladevan R

Zulkatli Hamzah gtIutrilional anaemia in pregnancy a study

at the Maternity Hospital Malaysan 1

Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL

Overview of country nutritional statu~ Proshy

cCIdings of theist Scientific Confernee of

the Nutrition Sociell of Malaysia 7 -24 I qXh

21 WHO Measuring change in nutritional status

Wmld Health Organization 1983

llQ

f

INTERNATIONAL SEMI~AR

ON NU RITION IN HEALTH AND DISEASE

Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991

University Of The Philippines Manila

Manila PhilippinE~s

INTERNATIONAL SEMINARI ON j NUTRITION IN HEALTH AND DISEASE ~ t ~ o

~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996

INTERNATIONAL CENTER FOR MEDICAL RESEARCH KOBE UNIVERSITY SCHOOL OF MEDICINE

COLLEGE OF PUBLIC HEALTH UNIVERSITY OF THE PHILIPPINES

MANILA

1

I

I

1 I I

Figure 1 Weightmiddotfor-Age of Malay Pre-School Children Peninsular Malaysia (sexHS combined)

20 ---------------------------- NeBS median

13

i6

25 45 55

(WHO 1983) --1l- shy

Upper income (McKay ct aI 1971)

-- -_

~~~~~) bullbullbullbullbulllt)bullbullbullbullbull

Rural villages (Chong Cl aL 1984)

- Aborigines

(Khor 1985)

-----shyRuralillages

(Chollg CL al 1972) -a--

Ag (yur)

2 Protein-Energy Malnutdtion

Sume recent data (Chen 1983 Chong lt aI

19S4 Khor 14S5) on groWl h perfnrmance nf preshy

~ch(lul chiluren d sh(wn in Figurl 1 Thc~e

~ eight-lor-age (bta were plotted S(lnle

data collected in tne 1 enOs (McKay et 31 1471

Chung et aL 1472) and the NCHS median (WHO

1 4S3) A general trend in growth performance II

these childnn may te seen and some ot th

i ncl ude

bull upper income children had better

age achievemnt than tnose from rural areas

bull an apparent gCiin in weight-for-age amnrg lhc

uf poor rural communities u cr

a decade period

bull there seemed to be less gain In

for the upper income group (for hich rlashy

tively less data arc available) after more than

a decad

bull the group 01 ao()rigine children studieu In Ille

mid-19HOs dpparcd tn be worse ()f thun the

Figue 2 Height-for-Age of Malay Pre-School Children Peninsular IIJ1aiaysia combined)

IW --------------------------------

Isexes

NCHSme4iau (HO1983) --tI- shy

Up~r income

liD ~~191Ii

100 I R=7~es(Cbong et aI 9S4) -b--shy

I Aboriginesj - i~) E 90shy

~ If I ~ ~

~ J01-fI

60 J__ ~----~-------- shy

05 15 35

Ige (years)

Sowc Ttl amp Klwr (1986

ural poor bld Ihildren

Th data or tl-e-c groups of chil shy

dren were Similarly plHICd tlnd -hown n

It iar he secn lhll

achievCIllLfll of the upper

llCllfllC chlldem hich ~lemd to Iprroxishy

nate the Nelf S meJ ian was cca rll better

Itlthan that (if he rural children

bull tlcre 1 1 Simi ar improviment in

lge lCf the laq decade anwng the rural preshy

choolhlluren

When ex n terms (1 -height

(FigUf ~)

bull the ru ral preschoolers shJwcd achicyclllcnh

It CJ2middotlJWr or the NeHS relercnc( middotn1H rrl

t -~--w a dnadc

bull thre as a ckar trend fer lhe upper income

I-hildrcn they possessed cightfumiddot-hcight

lchievcmtnls that range htlween X7 lO 95(1

~I ttl NCHS rl ennce

-----Ill


(sexes combined)

100

95

~ 13 E


p

85


---+-shy


--oooG-shy

A bullbullbulllgt




--1]

~

80 -------- shy05 25 35 45 55

Age (years)



Peninsular Malaysia

60 ~------middot---------------------------------------middot---~8~s~~

4950

40 38

Boy~ (0=4lt0) Girls (0=501)


III -- shy

~was~

II Was~ amp Stunted

lli~ UodexweJgtu

1 I



BOYS

k 40

U

u

(a)























L6---7----8----9---1O--~--~21

AGE (YLARS)




















lh~lll pn[lill

113

1




iChongetal198-1)



IAndcrson 197619771

h Inland Penan 45


Anderson1978b)



(Chen et aI 1981)



(Kandiah et aI 1


lt6 years lt 11


3 Anemia













lf












deficiency


Elhnic




lt 33ltf(


1( lt 50 u gJI


mean SO ((Ir )

(~lt 157r


(l lt 12 ngldl


median

lt3


lt 6 gdl


lt 3 gldl

104 lAx 180

308

104 603 458

240

117 6ll 18 plusmn 3507

453

117 1945 991

3R5

110 21 86 plusmn 2534

409

104 470 plusmn 506

315

452

117 603 035

365

117 324 024

111

109 1115 151

477

109 3475 450

312

L~1 4845 j 3353

603

121 1587 844

512

103 1109 880

612

101 330 plusmn 383

240 663

121 621 043

231

121 311 032

256

63 1051 middotiI1R

587

63 3367 ~42

476

71 4738 3~8-

()q()

71 1523 H39

549

67 1261 1532

627

66 247 244

160 773

71 613 06

254

71 29lt1 O()

465

D6 1113 17()

-U8

~76

3499 - 460 j I_J __

09 5265 t IU-ltJ

566

3U9 1708 921

472

2~(I

1569 1902

536

271 364= -Ll9

240

60L)

JOL) 612 039

2-S

3U4 31 J 1J30

24Q


L 5































tant task



(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353


n = 14


n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I


116

1

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA


(sexes combined)

100

95

~ 13 E


p

85


---+-shy


--oooG-shy

A bullbullbulllgt




--1]

~

80 -------- shy05 25 35 45 55

Age (years)



Peninsular Malaysia

60 ~------middot---------------------------------------middot---~8~s~~

4950

40 38

Boy~ (0=4lt0) Girls (0=501)


III -- shy

~was~

II Was~ amp Stunted

lli~ UodexweJgtu

1 I



BOYS

k 40

U

u

(a)























L6---7----8----9---1O--~--~21

AGE (YLARS)




















lh~lll pn[lill

113

1




iChongetal198-1)



IAndcrson 197619771

h Inland Penan 45


Anderson1978b)



(Chen et aI 1981)



(Kandiah et aI 1


lt6 years lt 11


3 Anemia













lf












deficiency


Elhnic




lt 33ltf(


1( lt 50 u gJI


mean SO ((Ir )

(~lt 157r


(l lt 12 ngldl


median

lt3


lt 6 gdl


lt 3 gldl

104 lAx 180

308

104 603 458

240

117 6ll 18 plusmn 3507

453

117 1945 991

3R5

110 21 86 plusmn 2534

409

104 470 plusmn 506

315

452

117 603 035

365

117 324 024

111

109 1115 151

477

109 3475 450

312

L~1 4845 j 3353

603

121 1587 844

512

103 1109 880

612

101 330 plusmn 383

240 663

121 621 043

231

121 311 032

256

63 1051 middotiI1R

587

63 3367 ~42

476

71 4738 3~8-

()q()

71 1523 H39

549

67 1261 1532

627

66 247 244

160 773

71 613 06

254

71 29lt1 O()

465

D6 1113 17()

-U8

~76

3499 - 460 j I_J __

09 5265 t IU-ltJ

566

3U9 1708 921

472

2~(I

1569 1902

536

271 364= -Ll9

240

60L)

JOL) 612 039

2-S

3U4 31 J 1J30

24Q


L 5































tant task



(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353


n = 14


n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I


116

1

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA



BOYS

k 40

U

u

(a)























L6---7----8----9---1O--~--~21

AGE (YLARS)




















lh~lll pn[lill

113

1




iChongetal198-1)



IAndcrson 197619771

h Inland Penan 45


Anderson1978b)



(Chen et aI 1981)



(Kandiah et aI 1


lt6 years lt 11


3 Anemia













lf












deficiency


Elhnic




lt 33ltf(


1( lt 50 u gJI


mean SO ((Ir )

(~lt 157r


(l lt 12 ngldl


median

lt3


lt 6 gdl


lt 3 gldl

104 lAx 180

308

104 603 458

240

117 6ll 18 plusmn 3507

453

117 1945 991

3R5

110 21 86 plusmn 2534

409

104 470 plusmn 506

315

452

117 603 035

365

117 324 024

111

109 1115 151

477

109 3475 450

312

L~1 4845 j 3353

603

121 1587 844

512

103 1109 880

612

101 330 plusmn 383

240 663

121 621 043

231

121 311 032

256

63 1051 middotiI1R

587

63 3367 ~42

476

71 4738 3~8-

()q()

71 1523 H39

549

67 1261 1532

627

66 247 244

160 773

71 613 06

254

71 29lt1 O()

465

D6 1113 17()

-U8

~76

3499 - 460 j I_J __

09 5265 t IU-ltJ

566

3U9 1708 921

472

2~(I

1569 1902

536

271 364= -Ll9

240

60L)

JOL) 612 039

2-S

3U4 31 J 1J30

24Q


L 5































tant task



(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353


n = 14


n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I


116

1

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA




iChongetal198-1)



IAndcrson 197619771

h Inland Penan 45


Anderson1978b)



(Chen et aI 1981)



(Kandiah et aI 1


lt6 years lt 11


3 Anemia













lf












deficiency


Elhnic




lt 33ltf(


1( lt 50 u gJI


mean SO ((Ir )

(~lt 157r


(l lt 12 ngldl


median

lt3


lt 6 gdl


lt 3 gldl

104 lAx 180

308

104 603 458

240

117 6ll 18 plusmn 3507

453

117 1945 991

3R5

110 21 86 plusmn 2534

409

104 470 plusmn 506

315

452

117 603 035

365

117 324 024

111

109 1115 151

477

109 3475 450

312

L~1 4845 j 3353

603

121 1587 844

512

103 1109 880

612

101 330 plusmn 383

240 663

121 621 043

231

121 311 032

256

63 1051 middotiI1R

587

63 3367 ~42

476

71 4738 3~8-

()q()

71 1523 H39

549

67 1261 1532

627

66 247 244

160 773

71 613 06

254

71 29lt1 O()

465

D6 1113 17()

-U8

~76

3499 - 460 j I_J __

09 5265 t IU-ltJ

566

3U9 1708 921

472

2~(I

1569 1902

536

271 364= -Ll9

240

60L)

JOL) 612 039

2-S

3U4 31 J 1J30

24Q


L 5































tant task



(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353


n = 14


n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I


116

1

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA


Elhnic




lt 33ltf(


1( lt 50 u gJI


mean SO ((Ir )

(~lt 157r


(l lt 12 ngldl


median

lt3


lt 6 gdl


lt 3 gldl

104 lAx 180

308

104 603 458

240

117 6ll 18 plusmn 3507

453

117 1945 991

3R5

110 21 86 plusmn 2534

409

104 470 plusmn 506

315

452

117 603 035

365

117 324 024

111

109 1115 151

477

109 3475 450

312

L~1 4845 j 3353

603

121 1587 844

512

103 1109 880

612

101 330 plusmn 383

240 663

121 621 043

231

121 311 032

256

63 1051 middotiI1R

587

63 3367 ~42

476

71 4738 3~8-

()q()

71 1523 H39

549

67 1261 1532

627

66 247 244

160 773

71 613 06

254

71 29lt1 O()

465

D6 1113 17()

-U8

~76

3499 - 460 j I_J __

09 5265 t IU-ltJ

566

3U9 1708 921

472

2~(I

1569 1902

536

271 364= -Ll9

240

60L)

JOL) 612 039

2-S

3U4 31 J 1J30

24Q


L 5































tant task



(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353


n = 14


n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I


116

1

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA































tant task



(ugdl) vitamin A

Pre-school

n =25

Primary school

n = 40

Boys 12-179 years

11

Girls 12-179 years

n 61

Men 18-459 years

n = 152

Women 18-459 years

n =353


n = 14


n = 14

31 plusmn 95

33 plusmn 125

44 plusmn 22

55 plusmn 19

46 19

47 plusmn 24

54 33

42 17

12

if)

3

7

12

(I


116

1

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA

5 Iodine Deficiency
















(Chen 1(81)





















10- 14 (fema Ie) 1 ~ 7Sh

Source Tan (19~2)

17

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA

6 Conclusions















ACKNOWLEDGEMENT





References

1 Anderson AJ U



vices 1976

2 Anderson AJU



3 Anderson AJU



Services 1978a

4 Anderson AJU



5 Chen PcY





MCC



7 Chen ST

















291984




Dugdale AE




1971




118

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA

14 Ravi T




sertation 1984




681982

16 Tee ES



17 Tee ES


18 Tee ES




1991




Rtprod Hlth 2(1) 32-501984

20 Te~ ES Kho~ GL






llQ

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA

f



Edited by

Lucila B Rabuco

Kazuo Chihara

Masato Kawabata

October 16-18 1991


Manila PhilippinE~s


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA


~ )

~

t o

Z

I

~ ~ I ) Z j

o m m ) ~ m

1996



MANILA

Documents

SPECIFIC NUTRIENT DEFICIENCIES IN MALAYSIA - NutriScene