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MINISTRY OF HEALTH MALAYSIA NUTRITION RESEARCH PRIORITIES IN MALAYSIA NUTRITION RESEARCH PRIORITIES IN MALAYSIA FOR 11 TH MALAYSIA PLAN (2016-2020) TECHNICAL WORKING GROUP ON NUTRITION RESEARCH NATIONAL COORDINATING COMMITTEE ON FOOD AND NUTRITION (NCCFN) MINISTRY OF HEALTH, MALAYSIA • 2016

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Page 1: research priorities in malaysia research priorities in malaysia

M I N I S T R Y O F H E A L T H M A L AY S I A

NUTRITIONRESEARCH PRIORITIESIN MALAYSIA

NUTRITIONRESEARCH PRIORITIESIN MALAYSIAFOR 11TH MALAYSIA PLAN(2016-2020)

TECHNICAL WORKING GROUP ON NUTRITION RESEARCHNATIONAL COORDINATING COMMITTEE ON FOOD AND NUTRITION (NCCFN)MINISTRY OF HEALTH, MALAYSIA • 2016

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NUTRITIONRESEARCH PRIORITIESIN MALAYSIAFOR 11TH MALAYSIA PLAN(2016-2020)

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

ii

ISBN: 978-967-0769-62-2

First Published in Malaysia 2016.

Copyright © National Coordinating Committee on Food andNutrition Ministry of Health, Malaysia, 2016.

All rights reserved. No part of this publication may be reproduced,stored in a retrieval system, or transmitted in any form or by anymeans, electronic, mechanical, photocopying, recording and/orotherwise, without the prior written permission from the publisher.Application for such permission should be addressed to theChairman, National Coordinating Committee on Food and Nutrition(NCCFN).

Published by:

Technical Working Group on Nutrition Research for NationalCoordinating Committee on Food and Nutrition

c/oNutrition DivisionMinistry of Health, MalaysiaLevel 1, Block E3, Complex EFederal Government Administration Centre62590 Putrajaya, MALAYSIA

Printed by:

NMZ NIAGA ENTERPRISE

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

iii

1. Prof. Dr. Norimah A.Karim • ChairpersonUniversiti Kebangsaan Malaysia

2. Norlida Zulkafly • SecretaryNutrition DivisionMinistry of Health Malaysia

3. Dr. Tahir ArisInstitute of Public HealthMinistry of Health Malaysia

4. Dr. S. Asmaliza IsmailNational Institute of Health, NIHMinistry of Health Malaysia

5. Siti Sa’adiah Hassan NudinInstitute of Health Behavioural ResearchMinistry of Health Malaysia

6. Rusidah SelamatNutrition DivisionMinistry of Health Malaysia

7. Dr. Chin Cheow KeatFood Safety and Quality DivisionMinistry of Health Malaysia

8. YBhg. Datin Dr. Rugayah BakriMedical Development DivisionMinistry of Health Malaysia

9. Normah OmarMalaysian Agricultural Research andDevelopment Institute

10. Dr. Yeo Wee KianNational Sports Institute

11. Nore’in Mohd ShukorMinistry of Regional and Rural Development

12. Dr. Haji Zabani bin Darus. AMNMinistry of Education

13. Prof. Dr. Aminah AbdullahUniversiti Kebangsaan Malaysia

14. Prof. Dr. Zalilah Mohd ShariffUniversiti Putra Malaysia

15. Prof. Dr. Wan Abdul Manan Wan MudaUniversiti Sains Malaysia

16. Prof. Madya Dr. Loh Su PengUniversiti Putra Malaysia

17. YBhg. Prof. Madya Datin Dr. Safiah Md. YusofUniversiti Teknologi MARA

18. Penolong Prof. Dr. Wan Azdie Mohd Abu BakarInternational Islamic University of Malaysia

19. Prof. Emeritus Dr. Mohd Ismail NoorTaylor’s University

20. Prof. Dr. Mirnalini KandiahUCSI University

21. Dr. Tee E. SiongNutrition Society of Malaysia (NSM)

22. Dr. Feisul Idzwan MustafaDisease Control DivisionMinistry of Health Malaysia

23. Dr. Nazma SallehFamily Health Development DivisionMinistry of Health Malaysia

24. Puziah SulaimanMinistry of Science, Technology and Innovation

25. Ahmad Ali ZainuddinInstitute for Public HealthMinistry of Health Malaysia

26. Dr. Mohd Fairulnizal Md. NohInstitute for Medical ResearchMinistry of Health Malaysia

27. Khairul Zarina Mohd YusopNutrition DivisionMinistry of Health Malaysia

28. W Nurul Ashikin W MohamadNutrition DivisionMinistry of Health Malaysia

Members Of Technical Working Group OfNutrition Research

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

iv

Chairperson : Prof. Dr. Norimah A. KarimUniversiti Kebangsaan Malaysia

Secretariat : Rusidah SelamatNorlida ZulkaflyW Nurul Ashikin W MohamadNutrition DivisionMinistry of Health Malaysia

Research Priority Area 1Maternal, Infant and Young Child Nutrition

Chairperson:

Dr. Zaharah SulaimanUniversiti Sains Malaysia

Members:

Prof. Dr. Zalilah Mohd SharifUniversiti Putra Malaysia

Dr. Fuziah Md ZainPutrajaya Hospital

Jamilah AhmadState Health Department of SelangorMinistry of Health Malaysia

Rashadiba Ibrahim @RahmanNutrition DivisionMinistry of Health Malaysia

Siti Mariam AliNational Lactation CentreSelayang Hospital

Aainaa Mastura Abu BakarCommunity Development Department (KEMAS)Ministry of Regional and Rural Development

Nutrition Research Priorities (Nrp) In Malaysia For 11thMalaysia Plan (2016-2020) Technical Committee

Area 1

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

v

Research Priority Area 2Monitoring and Evaluation of National Food and Nutrition Security,Nutritional Status and Programmes

Chairperson:

Prof. Dr. Norimah A.KarimUniversiti Kebangsaan Malaysia

Members:

Dr. Tahir ArisInstitute for Public HealthMinistry of Health Malaysia

Prof. Madya Dr. Mohd Nasir Mohd TaibUniversiti Putra Malaysia

Dr. Wan Azdie Mohd Abu BakarInternational Islamic University of Malaysia

Dr. Syaqirah AkmalMedical Development DivisionMinistry of Health Malaysia

Zaiton DaudNutrition DivisionMinistry of Health Malaysia

Junidah RaibNutrition DivisionMinistry of Health Malaysia

Tan Beng ChinState Health Department of SarawakMinistry of Health Malaysia

Mohamad Hasnan AhmadInstitute for Public HealthMinistry of Health Malaysia

Research Priority Area 3Life Course Food Intake and Dietary Practices

Chairperson:

Prof. Dr. Wan Manan Wan MudaUniversiti Sains Malaysia

Members:

YBhg. Prof. Madya Datin Dr. Safiah Md. YusofUniversiti Teknologi MARA

Dr. Mahenderan AppukuttyUniversiti Teknologi MARA/ Nutrition Society Malaysia

Dr. Haji Zabani Darus (AMN)Ministry of Education Malaysia

Siti Saadiah Hasan NudinInstitute for Health Behavioural ResearchMinistry of Health Malaysia

Dr. Nazma SallehFamily Health and Development DivisionMinistry of Health Malaysia

Khairul Zarina Mohd YusofNutrition DivisionMinistry of Health Malaysia

Ainan Nasrina IsmailNutrition DivisionMinistry of Health Malaysia

Nor Izati Abdul KarimMinistry of Agriculture and Agro-Based Industry

Area 3

Area 2

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

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Research Priority Area 4Macro and Micronutrient Excesses and Deficiencies

Chairperson:

Prof. Emeritus Dr. Khor Geok LinUniversiti Putra Malaysia

Members:

Prof. Madya Dr. Loh Su PengUniversiti Putra Malaysia

Prof. Madya Dr. Hamid Jan Jan MohamadUniversiti Sains Malaysia

Dr. Snigdha MisraInternational Medical University

Fatimah Zurina MohamadNutrition DivisionMinistry of Health Malaysia

Mohamad Soffian Mohamad RasidNutrition DivisionMinistry of Health Malaysia

Rashidah AmbakInstitute for Public HealthMinistry of Health Malaysia

Area 4

Research Priority Area 5Overweight and Obesity

Chairperson:

Prof. Emeritus Dr. Mohd Ismail NoorTaylor’s University

Members:

Prof. Dr. Poh Bee KoonUniversiti Kebangsaan Malaysia

Prof. Dr. Ruzita Abd TalibUniversiti Kebangsaan Malaysia

Prof. Madya Dr. Hazizi Abu SaadUniversiti Putra Malaysia

Prof. Jean Pierre PoulainTaylor’s University

Prof. Madya Dr. Muhammad Yazid JalaludinUniversiti Malaya

Nazli Suhardi IbrahimNutrition DivisionMinistry of Health Malaysia

Siti Shuhailah Shaikh Abdul RahimNutrition DivisionMinistry of Health Malaysia

Area 5

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Research Priority Area 6Diet Related Non-Communicable Diseases(Cancer, Diabetes and Cardiovascular Disease)

Chairperson:

Prof. Dr. Mirnalini KandiahUCSI University Malaysia

Members:

Rusidah SelamatNutrition DivisionMinistry of Health Malaysia

Prof. Madya Dr. Nik Shanita SafiiUniversiti Kebangsaan Malaysia

Satvinder Kaur d/o Nachatar SinghUCSI University Malaysia

Dr. Masni MohamadPutrajaya Hospital

Viola MichaelDisease Control DivisionMinistry of Health Malaysia

Azlinda A. HamidDistrict Health Office of Putrajaya

Area 6

Research Priority Area 7Food Composition Database

Chairperson:

Prof. Dr. Amin IsmailUniversiti Putra Malaysia

Members:

Prof. Dr. Aminah AbdullahUniversiti Kebangsaan Malaysia

Prof. Madya Dr. Azrina AzlanUniversiti Putra Malaysia

Dr. Mohd Fairulnizal Md. NohInstitute for Medical Research MalaysiaMinistry of Health Malaysia

Umi Kalsum Hussain ZakiMalaysian Agricultural Research and DevelopmentInstitute (MARDI)

Dr. Teng Kim TiuMalaysia Palm Oil Board (MPOB)

Anida@Azhana Husna ZainudeenFood Safety and Quality DivisionMinistry of Health Malaysia

Norliza Abdul HamidDepartment of Chemistry, Malaysia

Norhayati Mustafa KhalidInstitute for Medical Research MalaysiaMinistry of Health Malaysia

Norlida ZulkaflyNutrition DivisionMinistry of Health Malaysia

Nur Azlina Abdul AzizNutrition DivisionMinistry of Health Malaysia

W Nurul Ashikin W MohamadNutrition DivisionMinistry of Health Malaysia

Area 7

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The documentation of the Nutrition Research Priorities (NRP)in Malaysia for the 11th Malaysia Plan (2016-2020) was coordinated by the

Technical Working Group (TWG) on Nutrition Research, which is under thepurview of the National Coordinating Committee on Food and Nutrition

(NCCFN), Ministry of Health Malaysia. The Nutrition Division, Ministry ofHealth Malaysia served as the secretariat for the NRP.

Chairperson, TWG on Nutrition ResearchProf. Dr. Norimah A. Karim

Universiti Kebangsaan Malaysia

SecretariatRusidah SelamatNorlida Zulkafly

W Nurul Ashikin WMohamadNurAmirah Muhammadun Basar

Nor Shafinaz AzmiNutrition Division, Ministry of Health Malaysia

EditorProf. Emeritus Dr. Khor Geok Lin

Universiti Putra Malaysia

Coordination and Documentation

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

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The Nutrition Research Priorities in Malaysia (NRP) is a culmination of the close collaboration among many expertsfrom food, nutrition and health research. The development of the NRPwas coordinated by the Technical Working Groupon Nutrition Research, whose members represent various government agencies, the academia, professional societies andnon-government organisations.

The commendable efforts and valuable contributions from everyone involved in making this document a success aregreatly acknowledged. We wish to express sincere appreciation and gratitude to the:

• Director General of Health Malaysia, Deputy Director General of Health Malaysia (Research and TechnicalSupport), and Deputy Director General of Health Malaysia (Public Health).

• Chairperson of the National Coordinating Committee on Food and Nutrition, Chairperson of the TechnicalWorking Group on Nutrition Research and Chairperson of the Nutrition Research Priorities Technical Committee.

• Directors of the Nutrition Division, Food Safety and Quality Division, Family Health and Development Division,Disease Control Division and Medical Development Division, Ministry of Health Malaysia.

• Directors of the National Institutes of Health, Institute for Public Health, Institute for Medical Research andInstitute for Health Behavioural Research.

• Directors of the State Health Departments of Kuala Lumpur, Selangor and Sarawak.

• Director’s General of the Ministry of Education, Ministry of Regional and Rural Development, Ministry ofAgriculture andAgro-Based Industry, Ministry of Science, Technology and Innovation (MOSTI), Malaysia PalmOil Board (MPOB), Malaysian Agricultural Research and Development Institute (MARDI) and Department ofChemistry, Malaysia.

• Director of Putrajaya Hospital and Head of National Lactation Centre, Selayang Hospital.

• Dean of the Faculty of Health Sciences, Universiti Kebangsaan Malaysia; Dean of the Faculty of Science andTechnology, Universiti Kebangsaan Malaysia; Dean of the Faculty of Medical and Health Sciences, UniversitiPutra Malaysia; Dean of the School of Health Sciences, Universiti Sains Malaysia; Dean of the School of MedicalSciences, Universiti Sains Malaysia; Dean of the Faculty of Health Sciences, Universiti Teknologi Mara; Deanof the Faculty of Sports Science and Recreation; Dean of the Kulliyyah of Allied-Health Sciences, InternationalIslamic University; Dean of the Faculty of Medicine, Universiti Malaya; Dean of the School of Health Sciences,International Medical University; Dean of the Faculty of Applied Sciences, UCSI University and Dean of theSchool of Hospitality, Tourism and Culinary Arts, Taylor’s University.

• Presidents of Nutrition Society of Malaysia (NSM), and MalaysianAssociation for the Study of Obesity (MASO).

• All the chairpersons, rapporteurs, and participants of the workshops and all individuals who have directly andindirectly contributed to the completion of this document.

Acknowledgements

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

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TheMinistry of Health is strongly committed in

strengthening nutrition research in the country.

This commitment is portrayed by all the

supports and increased allocation of resources to carry

out nutrition research in the country.The publication of

this Nutrition Research Priorities is indeed timely, in line

with one of the facilitating strategies of the National

Plan of Action for Nutrition of Malaysia (NPANM III,

2016-2025).

With close collaboration and valuable inputs by experts

from various agencies and organizations in the country,

the Nutrition Research Priorities in Malaysia for 10th

Malaysia Plan (2011-2015) had been published in 2009.

As for the 11th Malaysia Plan (2016-2020), the Nutrition

Research Priorities in Malaysia is developed to continue

to address the gap of evidence in nutrition in the

country. One of the strategies in 11th Malaysia Plan

(2016-2020) is to increase health awareness through

collaboration with private sectors and non-

governmental organizations, including the industries,

universities and research institutions. Therefore, in this

11th Malaysia Plan Nutrition Research Priorities, all the

nutrition research scopes and topics have been

prioritised based on the national needs in order to give

the greatest impact.

I would like to convey my utmost appreciation and

congratulations to the Technical Working Group on

Nutrition Research under the National Coordinating

Committee on Food and Nutrition (NCCFN), especially

to the Nutrition Research Priorities Technical

Committee for the completion of this nutrition research

priority. It is my hope that all the relevant stakeholders

will use this document as the key reference in

prioritising nutrition research in the country. Thus, this

nutrition research priority would also be useful guide

especially for the funding agencies for more effective

allocation and management of research resources.

YBhg. Datuk Dr. Noor Hisham Bin Abdullah

Director General of Health Malaysia

Ministry of Health Malaysia

Foreword by Director General of Health Malaysia

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

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First and foremost, I would like to congratulate

and extend my heartfelt appreciation to the

Nutrition Research Priorities (NRP) Technical

Committee for their effort to formulate the Nutrition

Research Priorities in Malaysia for 11th Malaysia Plan

(2016-2020). This committee is set up under the

TechnicalWorking Group on Nutrition Research which

is established under the National Coordinating

Committee on Food and Nutrition (NCCFN). Previously,

Nutrition Research Priorities in Malaysia for 11th

Malaysia Plan (2011-2015) had been published in 2009.

This NRP is developed through commendable efforts

from experts of various ministries, universities,

agencies, institutions and organisations.

One of the activities under the strategy to strengthen

food and nutrition research in the National Plan of

Action for Nutrition of Malaysia (NPANM III, 2016-2025)

is the establishment of Nutrition Research Priorities in

Malaysia.With the publication of this document, it will

hopefully help to facilitate the policy makers, funding

agencies, research institutions and researchers in

prioritizing nutrition research for more effective

allocation of resources. It is also hoped that there will be

more concerted effort from all the relevant stakeholders

to carry out nutrition research in the country, taking into

consideration this Nutrition Research Priorities.

YBhg. Datuk Dr. Lokman Hakim Bin Sulaiman

Deputy Director General of Health

(Public Health) Chairperson

National Coordinating Committee on Food and

Nutrition (NCCFN)

Ministry of Health Malaysia

Foreword by Chairperson of DeputyDirector General of Health (Public Health)

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Foreword by Chairperson of Technical Working Group onNutrition Research

Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

xii

First of all I would like to express my warm and

sincere appreciation to the Ministry of Health

and all the committee members who have

directly and indirectly contributed, with their

painstaking efforts towards the successful completion

and publication of this document.

One of the main tasks of the Technical Working Group

on Nutrition Research is to identify research priorities in

nutrition for the country.This document is published to

ensure that nutrition research carried out in the country

is in accordance with the national priorities and current

needs. Previous edition of Nutrition Research Priorities

in Malaysia for 10thMalaysia Plan (2011-2015) has been

published in 2009.

This Nutrition Research Priorities in Malaysia for 11th

Malaysia Plan (2016-2020) is the result of the hard work

and dedication of the experts from various institutions,

universities, professional bodies and non-governmental

organisations to reduce the gap of evidence in nutrition.

It is hoped that this document will serve as a useful

guide for policy makers, funding agencies,

academicians and researchers in prioritising nutrition

research in this country.

Prof. Dr. Norimah A. Karim

Chairperson

TechnicalWorking Group on Nutrition Research

National Coordinating Committee on Food and

Nutrition (NCCFN)

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Members of Technical Working Group on Nutrition Research

Members of Nutrition Research Priorities In Malaysia for 11th MP (2016-2020) Technical Committee

Coordination and Documentation

Acknowledgements

Foreword by Director General of Health Malaysia

Foreword by Chairperson of Deputy Director General of Health (Public Health)

Foreword by Chairperson of Technical Working Group on Nutrition Research

Table of Contents

List of Figures

List of Tables

Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2020)

Executive Summary

Introduction

Research Priority Area 1: Maternal, Infant and Young Child Nutrition

1.1 Introduction

1.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

1.3 Table of Nutrition Research Priority Area

References

iii

iv

viii

ix

x

xi

xii

xiii

xvi

xvii

xviii

xxiii

3

4

5

10

Table of Contents

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Research Priority Area 2: Monitoring and Evaluation of National Food and NutritionSecurity, Nutritional Status and Programmes

2.1 Introduction

2.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

2.3 Table of Nutrition Research Priority Area

References

Research Priority Area 3: Life Course Food Intake and Dietary Practices

3.1 Introduction

3.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

3.3 Table of Nutrition Research Priority Area

References

Research Priority Area 4: Macro and Micronutrient Excesses and Deficiencies

4.1 Introduction

4.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

4.3 Table of Nutrition Research Priority Area

References

Research Priority Area 5: Overweight and Obesity

5.1 Introduction

5.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

5.3 Table of Nutrition Research Priority Area

References

13

14

15

18

21

22

23

26

28

29

30

32

35

37

38

44

Table of Contents

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Research Priority Area 6: Diet Related Non-Communicable Diseases (Cancer, Diabetesand Cardiovascular Disease)

6.1 Introduction

6.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

6.3 Table of Nutrition Research Priority Area

References

Research Priority Area 7: Food Composition Database

7.1 Introduction

7.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

7.3 Table of Nutrition Research Priority Area

References

Appendices

Ranking Criteria for Suggested Topics in Each Research Scope

Appendix 1 • Maternal, Infant and Young Child Nutrition

Appendix 2 • Monitoring and Evaluation of National Food and Nutrition Security,Nutritional Status and Programmes

Appendix 3 • Life Course Food Intake and Dietary Practices

Appendix 4 • Macro and Micronutrient Excesses and Deficiencies

Appendix 5 • Overweight and Obesity

Appendix 6 • Diet Related Non-Communicable Diseases (Cancer, Diabetes andCardiovascular Disease)

Appendix 7 • Food Composition Database

Abbreviations

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49

50

52

55

57

58

60

62

72

78

86

90

104

110

114

Table of Contents

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List Of Figures

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Figure : Linkages between Nutrition Research Priority Area of NRP for 11th MP and the

Introduction_1 enabling strategies of NPANM III, 2016-2025.

Figure 1.1 : Purpose and scope of maternal, infant and young child nutrition.

Figure 2.1 : Purpose and scope of monitoring and evaluation of national food and nutrition

security, nutritional status and programmes.

Figure 3.1 : Purpose and scope of life course food intake and dietary practices.

Figure 4.1 : Purpose and scope of macro and micronutrient excesses and deficiencies.

Figure 5.1 : Complexity in tackling Obesity (Foresight Report, UK (2007).

Figure 5.2 : Purpose and scope of overweight and obesity.

Figure 6.1 : Disability Adjusted Life Years (DALYs) by major disease groups, Malaysia, 2008.

Figure 6.2 : Purpose and scope of diet-related non-communicable diseases (cancer, diabetes

and cardiovascular disease).

Figure 7.1 : Uses of food composition data.

Figure 7.2 : Food database towards preventing nutrition-related problems.

Figure 7.3 : Purpose and scope of food composition database.

xxiv

4

14

22

29

35

37

46

49

55

56

57

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List Of Tables

Table : NRP areas, purpose and scope.

Executive_1

Table : Ranking criteria for selection of research scopes and topics.

Introduction_1

Table : Comparison between previous (10th MP) and current (11th MP) Research

Introduction_2 Priority Areas.

Table 1.1 : Relative ranks for suggested topics in each research scope.

Table 2.1 : Relative ranks for suggested topics in each research scope.

Table 3.1 : Relative ranks for suggested topics in each research scope.

Table 4.1 : Relative ranks for suggested topics in each research scope.

Table 5.1 : Relative ranks for suggested topics in each research scope.

Table 6.1 : Top 10 causes of premature mortality (YLLs), Malaysia, 2008.

Table 6.2 : Top 10 causes of burden of disease (DALYs), Malaysia, 2008.

Table 6.3 : Relative ranks for suggested topics in each research scope.

Table 7.1 : Relative ranks for suggested topics in each research scope.

xix

xxv

xxvi

5

15

23

30

38

47

47

50

58

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Nutrition Research Priorities In Malaysia ForThe 11th Malaysia Plan (2016-2020)

Executive Summary

In the 10th Malaysia Plan (MP) (2011-2015), healthcare improvements were achieved

including increase in life expectancy at birth, decrease in infant and maternal mortality rates,

and access to healthcare services. Improving the well-being of the population continues to

be one of the strategic thrusts for realising the Vision 2020 of the 11th MP (2016-2020).

In this conjunction, the National Plan of Action for Nutrition of Malaysia (NPANM) III

(2016-2025) provides the strategies and activities for achieving optimal nutritional well-being

of Malaysians. Strengthening Food and Nutrition Research and Development is one of the

facilitating strategies of NPANM III towards supporting the effective implementation and

evaluation of nutrition programmes in the country. Hence, the Nutrition Research Priorities in

Malaysia (NRP) (2016-2020) was developed with the primary objectives of highlighting

important nutrition research gaps and identifying issues that warrant further research,

especially in the Malaysian context. Essentially, all the research and development activities

proposed in this NRP were prioritised based on national needs as delineated in NPANM III

(2016-2025).

Seven NRP (2016-2020) Areas have been identified for the 11th MP (Refer to Table Executive_1

NRP areas, purpose and scope). These 7 NRP Areas are considered equally important in terms

of meeting the country’s needs for further information and data required for improving the

health and nutritional well-being of the population. Ranking according to order of priority is

only made for the suggested topics within each NRP Area.

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Table Executive_1 : NRP areas, purpose and scope

No. Research priority area* Research purpose Research scope

1. Maternal, infant and young A. Assess relationship between A1. Effects of maternal anaemia on maternal, infantchild nutrition. maternal nutritional status and and young child health and nutrition

health outcomes of mother, infantand young child in later stages of life. A2. Effects of inappropriate gestational weight gain

on maternal, infant and young child health andnutrition.

A3. Effects of gestational diabetes mellitus onmaternal, infant and young child on health andnutrition.

B. Determine nutritional status of B1. Impact of caregivers feeding practices oninfants and young children. nutritional status of infant and young child (IYC).

B2. Infant and young child feeding practices andhealth outcomes.

B3. Dietary adequacy of infant and young child

B4. IYC feeding practices among infant and youngchild of marginalised groups (single mothers,homeless, hard core and urban poor).

B5. Feeding practices among infant and young childwith special needs (e.g. cerebral palsy and HIV).

C. Strengthen implementation/ C1. Evaluation of current strategies/ programmes/service delivery. policies.

D. Develop policies on infant feeding D1. Impact of advertisement, labelling and packagingcode of protection.

D2. Impact of mother-friendly support at workplace

D3. Strengthening the current strategies/programmes/ policies on maternal, infant and youngchild nutrition.

2. Monitoring and Evaluation of A. Strengthen monitoring and A1. Conduct regularly national surveys forNational Food and Nutrition evaluation of national food and monitoring global/ national nutrition indicators.Security, Nutritional Status nutrition security, nutritional statusand Programmes. and programmes. A2. Evaluate existing national nutrition programmes

of MOH/ other stakeholders.

A3. Develop real time data collection tools andanalysis for nutrition studies

A4. Enhance MyNutriApps for monitoring andevaluation of population dietary intake

B. Monitoring national nutritional B1. Carry out national nutrition surveys onstatus and trend. vulnerable groups (under 5 children, women

of reproductive age & indigenous population groups)at regular interval.

B2. Determine national foods and nutrition transitionof the Malaysian population over time.

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No. Research priority area* Research purpose Research scope

C. Determination of factors C1. Determine factors influencing food and nutritioninfluencing food and nutrition security.security in the food systems.

C2. Determine micronutrient intake and biomarkers.

3. Life Course Food Intake and A. To understand food intake and A1. Impact of nutrition on healthy growth andDietary Practices. dietary practices among various age development.

groups.A2. Determination of environmental and societalfactors affecting foods and nutrition.

A3. Determination of nutrition-related behaviour ofvarious age groups.

A4. Evaluation of variability in responses to diets andfood intake.

B. Effective strategies/ programmes B1. Identification of effective interventions to promoteto promote healthy dietary practices healthy dietary practices among various age groups.among various age groups.

C. To understand the consequences C1. Determination on consequences of unhealthyof unhealthy dietary practices on dietary practices of various age groups.health status in later stages of life.

C2. Identification of under and over nutrition and theeffect on health status in later stages of life.

4. Macro and Micronutrient A. Strengthen epidemiological and A1. Assessment of association between macro andExcesses and Deficiencies. clinical understanding. micronutrient status with health outcomes.

B. Develop and evaluate appropriate B1. Evaluation of current intervention strategies onstudies and intervention strategies. macronutrient intake and status.

B2. Evaluation of current intervention strategies onmicronutrient intake and status.

B3. Development of novel studies and strategies toimprove macro and micronutrient status of all agegroups.

5. Overweight and Obesity. A. Improve understanding on the A1. Determination of BMI and WC cut-offs forepidemiology of obesity. Malaysians.

A2. Relationship between adiposity andcardiovascular risk factor.

A3. Impact of early nutrition on development of adultobesity.

A4. Impact of obesity to economic and social cost inMalaysia.

A5. Association of dietary intake, appetite control andeating behaviour with obesity in Malaysia.

A6. Determination of socio-cultural factors influencingobesity.

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No. Research priority area* Research purpose Research scope

A7. Effect of metabolic predisposition to onset ofobesity.

A8. Association between sedentary lifestyle andobesity.

A9. Determination of genetic factors influencingdevelopment of overweight and obesity.

B. Improve effectiveness of B1. Development and evaluation of obesity preventionintervention and management of and intervention.obesity.

B2. Development and evaluation of obesitymanagement

B3. Impact of policies and environment on obesity

C. Developing new modalities. C1. Identification of method to define obesity

C2. Identification of novel strategies to preventobesity

6. Diet Related Non- A. Review the epidemiology of NCDs. A1. Consolidation of available epidemiology andCommunicable Diseases aetiology data in relation to diet-related NCDs in(Cancer, Diabetes and Malaysia.Cardiovascular Disease).

A2. Case control/ cohort studies on diet and lifestylerisk factors in relation to NCDs and metabolicsyndrome in multi-ethnic population groups

A3. Dietary patterns in association with NCDs andmetabolic syndrome

A4. Social and environmental factors in associationwith NCDs and metabolic syndrome

B. Conduct diet and lifestyle B1. Intervention studies in different settingsintervention studies. (community, institution, work place, school).

B2. Impact of policies on NCDs.

B3. Assess roles of functional foods in NCDsprevention and management.

C. Develop new modalities: C1. Developments of functional foods/diagnosis & treatment. nutraceuticals/ dietary supplements for addressing

development of NCDs.

C2. Identify nutritional biomarker of NCDs inMalaysia.

C3. Develop innovative techniques for dietaryassessment training and interventions.

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No. Research priority area* Research purpose Research scope

7. Food Composition A. Update data in the current FCD. A1. Update data on existing macro andDatabase (FCD). micronutrients (e.g. fatty acids, vitamins and

minerals) through collation of various database anddevelopment of a quality data collection procedures.

B. Expand the FCD. B1. Add new food items

B2. Inclusion of nutrient retention of new andunderutilised foods

C. Add new data on phytochemical C1. Analysis of types and amounts of phytochemicaland anti-nutrients. and anti-nutrients.

D. Improvement in methodologies. D1. Improve methods/ methodologies (i.e. Labanalysis, sampling, storage, and etc.)

D2. Establishment of reliable, accurate and validmethods of nutrient analysis.

*The Research Priority Areas No. 1 to No. 7 are considered equally important for consideration of financial support and otherresources.

The development of the current NRP was in accordance with the procedure of the previous NRP for the 10th MP (2011-2015). Thesesteps included identifying:

i) Critical gaps in knowledge and research needs for the Malaysian context.

ii) The research purposes, scopes and suggested topics within each NRP Areas.

iii) The relative ranking of the research topics using standardised criteria.

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Background

Good nutrition contributes to optimal nutritional well-being of the population. This will directlyimprove productivity and eventually contributes to the economic development of the country. Hence,improving health and nutritional well-being of the people is one of the strategic thrusts of the 11th

Malaysia Plan (11th MP) (2016-2020). In supporting this important strategy of the 11th MalaysiaPlan, the National Plan of Action for Nutrition of Malaysia (NPANM) III (2016-2025) was establishedwith appropriate strategies and activities towards attaining optimal nutritional well-being of all.Among the Facilitating Strategies of the NPANM III for supporting the effective implementation andevaluation of nutrition programmes in the country is “Strengthening Food and Nutrition Researchand Development”. Towards this end, the Nutrition Research Priorities in Malaysia (NRP) (2016-2020) was developed for the 11th MP with the main objective of prioritising research areas andtopics based on national needs as delineated in NPANM III (2016 - 2025).

The NRP (2016-2020) was developed by the NRP Technical Committee comprising experiencedresearchers representing various government agencies, professional bodies, academia, and non-governmental organisations (NGOs). The members are experts from the fields of nutrition, foodscience, public health, medicine, health epidemiology and education. The NRP Technical Committeeis part of the Technical Working Group on Nutrition Research, which is under the purview of theNational Coordinating Committee on Food and Nutrition (NCCFN).

Priority areas and topics for research were determined through a series of workshops and meetingsheld in 2015-2016. Relevant national and international publications were reviewed to identify gapsof evidence or knowledge especially for the Malaysian context. In this way, a total of seven NRPAreas were identified. Each NRP provides a conceptual framework for its purpose and scope forresearch that is aligned with one or more of the Enabling Strategies of the NPANM III. Specifically,each NRP Area addresses the indicators and targets of the Enabling Strategies that the NRP Areais aligned with. Through these links, the NRPs are expected to generate data needed to support therealisation of the Enabling Strategies, and in turn, the achievement of the objectives of the NPANMIII by 2025.

Figure Introduction_1 illustrates the linkage, between the Nutrition Research Priority Areas in the11thMP and the enabling strategies of NPANM III (2016-2025).

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Nutrition Research Priorities In Malaysia ForThe 11th Malaysia Plan (2016-2020)

Introduction

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Maternal, Infant and Young Child Nutrition

Diet Related Non-Communicable Diseases

(Cancer, Diabetes and Cardiovascular Disease)

Life Course FoodIntake and Dietary Practices

Overweight and Obesity

Monitoring and Evaluation of National Foodand Nutrition Security,

Nutritional Status and Programmes

Macro and Micronutrient Excesses and Deficiencies

Food Composition Database

Promoting maternal, infant and young child

nutrition

1

Promoting healthy eating

and active living

2

Preventing andcontrolling nutritional

deficiencies

3

Preventing andcontrolling obesity

and other diet related NCDs

4

Sustaining foodsystems to promote

healthy diets

5

Supporting efforts to

promote food safety and

quality

6

EnablingStrategies of

NPANM III, 2016-2025

EnablingStrategies of

NPANM III,2016-2025

Nutrition Research Priority Areas in Malaysia for 11th MP (2016-2020)

Figure Introduction_1: Linkages between Nutrition Research Priority Areas in Malaysia for 11th MPand the enabling strategies of NPANM III, 2016-2025

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No. Criteria Ranking criteria(Score) Remarks

1. Primary criteria Big impact on health status and/or delivery of services 1-10 Need to applyboth criterias

Great public health significance 1-10

2. Secondary criteria Capacity strengthening 1-7 Need to applymaximum

Gap in knowledge /evidence that necessitates research 1-7 2 criterias

Feasibility, practically, cost and time 1-7

Importance for client satisfaction 1-7

Ranking Criteria for Research Topics

All the NRP research topics for the 11th MP were ranked based on the following criteria:

• Big Impact on Health Status and/ or Delivery of Services

• Great Public Health Significance

• Capacity Strengthening

• Gap in Knowledge/ Evidence that Necessitates Research

• Feasibility, Practicality, Cost and Time

• Importance for Client Satisfaction

The first two criteria were considered primary criteria while the remaining four criteria were secondary criteria, as shown in TableIntroduction_1.

For each research scope, these criteria were used to rank the relative priorities of the research topics. Score “1” indicates the lowestscore for each criteria. The scores obtained by each research topic were added, and the research topic that obtained the highesttotal score was ranked ‘‘1’’ and so on.

Table Introduction_1: Ranking criteria for selection of research scopes and topics

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Comparison Between NRP Areas of the 10th MP and 11th MP

The current NRP Areas were revised in line with the Enabling and Facilitating Strategies of the NPANM III. Comparison between theNRP Areas for the 10th MP and 11th MP is shown in Table Introduction_2.

Table Introduction_2: Comparison between previous (10th MP) and current (11th MP) Research Priority Areas.

No. NRP for 10th MP NRP for 11th MP

1. Infant Feeding and Complementary Feeding Practices. Maternal, Infant and Young Child Nutrition.

2. Monitoring of National Nutritional Status. Monitoring and Evaluation of National Food and NutritionSecurity, Nutritional Status and Programmes.

3. Food Intake and Healthy Dietary Practices Across the Life Course Food Intake and Dietary Practices.Lifespan.

4. Macro and Micronutrient Excesses and Deficiencies. Macro and Micronutrient Excesses and Deficiencies.

5. Overweight and Obesity. Overweight and Obesity.

6. Diet-Related Non-Communicable Diseases. Diet-Related Non-Communicable Diseases (Cancer,Diabetes and Cardiovascular Disease).

7. Food Composition Database for Nutrient and Food Composition Database.Non-nutrient Component.

National Health/ Nutrition Surveys Since The 10th MP

Since the implementation of the previous Nutrition Research Priorities for 10th Malaysia Plan (2011 - 2015), several national nutritionstudies have been carried out, as outlined below:

1. National Health and Morbidity Survey (NHMS) 2011

2. Malaysia School-Based Nutrition Survey (MSNS) 2012

3. Malaysian Adult Nutrition Survey (MANS) 2014

4. National Health and Morbidity Survey (NHMS) 2015

The NHMS has been an important platform for providing results that are used to monitor the national nutritional status of thepopulation in Malaysia. The findings of the NHMS have also provided significant benefits to the Ministry of Health for better planning,monitoring and evaluation of the programmes. The NRP for the 11th MP will serve as a useful reference for research in generatingvaluable information and knowledge towards improving the health and nutritional well-being of all.

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References

Economic Planning Unit (2015). Eleventh Malaysia Plan 2015-2020. Prime Minister Department. Putrajaya, Malaysia.

Technical Working Group on Nutrition Research, National Coordinating Committee on Food and Nutrition. (2009). Nutrition ResearchPriorities in Malaysia for 10th Malaysia Plan. Ministry of Health, Malaysia.

National Coordinating Committee on Food and Nutrition (NCCFN) (2011). Mid-Term Review National Plan of Action for Nutrition ofMalaysia (NPANM) 2006-2015, Ministry of Health, Malaysia.

National Coordinating Committee on Food and Nutrition (NCCFN) (2015). National Plan of Action for Nutrition of Malaysia (NPANM)2016-2025, Ministry of Health, Malaysia.

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Nutrition Research Priorities in Malaysia for 11th Malaysia Plan (2016-2025)

1

Area 1Maternal, Infant andYoung Child Nutrition

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1.0 Maternal, Infant And Young Child Nutrition

1.1 Introduction

The first 1000 days of life span is from conception until the child reaches the age of two. It is an important periodof growth and development whereby any disturbance that occurs during this critical period could have a profoundimpact on a child’s ability to grow and develop. Besides that, his or her future risk of developing adult diseases suchas diabetes, cardiovascular disease and cancer is also increased. As the foetus is dependent on the mother for itsnutrition, maternal diet and nutritional status during pregnancy is crucial for foetal health and development. Inaddition, the interaction between foetal and postnatal experiences could also impact the link between foetal growthand adult diseases. The growing body of evidence on the link between early life nutrition with health and disease inlater life further supports the importance of good nutrition and care of women and infants during the first 1000days of life.

During pregnancy, energy and nutrient requirements of women increase in order to meet both maternal and foetaldemands. Insufficient or excessive gestational weight gain, micronutrient deficiencies and gestational diabetes areamong the nutritional problems prevalent in pregnant women. These nutritional problems can have short-term andlong-term adverse effects on health of women and their offsprings. For example, gaining weight out of therecommended range of gestational weight gain or gestational diabetes increases the risk of pregnancy inducedhypertension, caesarean delivery, preterm birth and small- or large-for-gestational age infant. Women with excessivegestational weight gain or gestational diabetes, may also have higher risks of postpartum weight retention, obesity,cardiovascular disease and type 2 diabetes mellitus.

The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life andcontinuation of breastfeeding for 2 years (WHO, 2001). The WHO and UNICEF have articulated a global strategy forinfant and young child feeding and recommendations in the form of guiding principles for complementary feedingof the breastfed and non-breastfed children (WHO, 2004; WHO, 2005). Exclusive breastfeeding confers many benefitsto both infant and mother, which include a lower risk of gastrointestinal infection for the infant and rapid post-partum weight loss for the mother. Breastfeeding also lowers the risk of breast and ovarian cancer in mother. Inaddition, the American Academy of Pediatrics (AAP) states that breastfeeding plays a role in the prevention of suddeninfant death syndrome (SIDS), which is one of the main causes of infant mortality.

Complementary feeding, which typically covers the period from 6 to 24 months of age, is a critical period of transitionfrom exclusive breastfeeding to feeding of family foods. As exclusive breastfeeding is no longer adequate to meetthe energy and nutrient requirements of an infant, complementary foods should be introduced from 6 month ofage. Malnutrition typically occurs in infants due to inadequate quantity and poor quality of complementary foods.In many low income countries, children do not receive nutritionally adequate and safe complementary foods. Onlyone third of breastfed infants met the criteria of dietary diversity and feeding frequency of complementary foods thatare appropriate for their age (WHO, 2001). Complementary feeding should be timely, adequate, safe and appropriatein addition to the continuation of breastfeeding to ensure infants and young children have optimal diets.

The Third National Health and Morbidity Survey (NHMS III) showed that in 2006, the overall prevalence of exclusivebreastfeeding among infants (< 6 months old) was only 14.5%. For complementary feeding, only 41.5% infantsreceived timely complementary feeding (between the ages of six to ten months) and complementary food was givento infants as early as two months of age. In addition, only 55.9% of children aged 9 to 23 months received at least3 meals a day (IPH, 2008).

Malaysia lacks data on maternal, infant and young child nutrition. Research is much needed on various aspects ofmaternal diet and nutritional status during pregnancy, infant and complementary feeding practices. These includeresearch on intakes of energy and nutrients as well as dietary patterns of pregnant women, consequences of maternalnutritional status, dietary adequacy in infants and young children. In addition, infant and young child feeding practicesof minority population groups, low birth weight and premature infants is needed.

In conclusion, the process of developing new strategies that could enhance the health and nutritional status ofpregnant women, infant and young children in Malaysia can be undertaken if only adequate information is availablethrough related research.

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1.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

Maternal, Infant and Young Child Nutrition

Assess relationshipbetween maternal

nutritional status andhealth outcomes of

mother, infant and youngchild in later stages of life

A

Effects of maternalanaemia on maternal,infant and young childhealth and nutrition

A1

Effects of inappropriategestational weight gainon maternal, infant andyoung child health and

nutrition

A2

Effects of gestationaldiabetes mellitus onmaternal, infant and

young child on health andnutrition

A3

Determine nutritionalstatus of infants andyoung children

B

Impact of caregiversfeeding practices on

nutritional status of infantand young child (IYC)

B1

Infant and young childfeeding practices andhealth outcomes

B2

Dietary adequacy ofinfant and young child

B3

IYC feeding practicesamong infant and youngchild of marginalised

groups (single mothers,homeless, hardcore and

urban poor)

B4

Feeding practices amonginfant and young childwith special needs (e.g.cerebral palsy and HIV)

B5

Strengthenimplementation/ service

delivery

C

Evaluation of currentstrategies/ programmes/

policies

C1

Develop policies on infantfeeding code ofprotection

D

Advertisement, labellingand packaging

D1

Impact of mother-friendlysupport at workplace

D2

Strengthening the currentstrategies/ programmes/policies on maternal,infant and young child

nutrition

D3

Figure 1.1 : Purpose and scope of maternal, infant and young child nutrition

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1.3 Table of Nutrition Research Priority Area

This NRP Area is presented in two tables. Table 1.1 presents the relative ranks for suggested topics. Appendix 1presents the ranking criteria for the suggested topics in each research scope of this NRP Area.

Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

A. Assess A 1. Effects of There is limited By knowing the status A 1.1 The impact of 1relationship between maternal anaemia on information on the of anaemia, anaemia on maternalmaternal nutritional maternal, infant and impact of anaemia on appropriate chronic disease,status and health young child health chronic disease, intervention can be psychological andoutcomes of mother, and nutrition. psychological and taken to treat and cognitive outcomeinfant and young child cognitive outcome. prevent maternalin later stages of life. related diseases. A 1.2 The impact of 2

anaemia on infantand young childgrowth anddevelopment

A 2. Effects of There is limited By knowing the status A 2.1 The impact of 1inappropriate information on the of gestational weight inappropriategestational weight impact of gain, appropriate gestational weightgain on maternal, inappropriate intervention can be gain on maternalinfant and young gestational weight taken to treat and health and nutrition.child on health and gain on maternal prevent relatednutrition. chronic disease, consequences. A 2.2 The impact of 2

psychological and gestational weightcognitive outcome. gain on infant and

young child healthand nutrition.

A 3. Effects of There is limited Gestational diabetes A 3.1 The impact of 1gestational diabetes information on the mellitus can have gestational diabetesmellitus on maternal, impact of gestational adverse consequences mellitus on maternalinfant and young diabetes mellitus on on maternal and child health and nutrition.child health and maternal, infant and health.nutrition. young child health. A 3.2 The impact of 2

gestational diabetesmellitus on infantand young childhealth and nutrition.

B. Determine B 1. Impact of The availability of Care feeding practices B 1.1 Determinants 1nutritional status of caregivers feeding local studies on this (controlling, of infant and younginfants and young practices on issue is limited. restricting or child feeding practiceschildren. nutritional status of responsive) have of caregivers.

infant and young been shown to havechild (IYC). an impact on B 1.2 Impact of care 2

nutritional status of feeding practices oninfant and young child developmentchild. (cognitive,

psychomotor andpsycho-social).

Table 1.1: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

B 2. Infant and young The availablity of local Infant and young child B 2.1 Relationship 1child feeding practices studies on these feeding has a long between infant andand health outcomes. issues are limited. term impact on young child feeding

growth, development practices withand health status. malnutrition

(overweight, obesity,underweight, stuntingand wasting)

B 2.2 Relationship 5between infant andyoung child feedingwith diet-relatedchronic diseases inchildren, adolescentsand adults.

B 2.3 Relationship 4between infant andyoung child feedingpractices withinfections andallergies (acuterespiratory infection,asthma, gastroenterities, eczema).

B 2.4 Relationship 3between infant andyoung child feedingwith micronutrientadequacy.

B 2.5 Relationship 6between infant andyoung child feedingwith macronutrientadequacy.

B 2.6 Impact of 2infant and youngchild feedingpractices on theirdevelopment(cognitive,psychomotor andpsycho-social).

B 3. Dietary adequacy Local studies on this Dietary adequacy is B 3.1 Dietary 1of infant and young area are lacking. important for better patterns ** amongchild. growth and infants and young

development. child.** Complementaryfeeding practices(timely, adequacy,types, frequency,safety).

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

B 3.2 The use and 2impact of dietarysupplements (eg:vitamins, minerals)on infant and youngchild health andnutrition.

B 4. IYC Feeding More information is Socio-culture B 4.1 Dietary patterns 1practices among needed for health differences among the and nutritional statusinfant and young and nutrition various marginalised among infant andchild of marginalised intervention strategies groups (single young child ofgroups (single mothers, homeless, marginalisedmothers, homeless, hardcore and urban groups (singlehardcore and urban poor) affect feeding mothers, homeless,poor). practices, dietary hardcore and urban

intake and nutritional poor).status. Information isrequired to addressthe service needs ofthe marginalisedgroups (singlemothers, homeless,hardcore and urbanpoor).

B 5. Feeding practices Lack of information Information is B 5.1 Dietary 1among infant and on feeding practices required to address patterns andyoung child with among infant and feeding practices nutritional statusspecial needs (e.g. young child with among infant and among infant andcerebral palsy and special needs (e.g. young child with young child with HIVHIV) cerebral palsy and special needs and cerebral palsy.

HIV) in Malaysia. (cerebral palsy andHIV).

C. Strengthen C 1. Evaluation of Information on Many programmes C 1.1 Evaluate the 4implementation/ current strategies/ evaluation of infant have been effectiveness ofservice delivery. programmes/ policies. and young child implemented over nutrition education

feeding strategies/ the years. Hence, on IYC at healthprogrammes/ evaluation is needed clinics.activities is limited. to assess the

effectiveness of the C 1.2 Evaluate the 1programmes. effectiveness of

post natal homevisit on breastfeedingpractices.

C 1.3 Evaluate the 3effectiveness ofmother friendly carein BFHI setting.

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

C 1.4 Evaluate 5knowledge, attitudeand practice onbreastfeeding andcomplementaryfeeding amongcaregivers.

C 1.5 Evaluate the 2effectiveness oflactation training onhealth care providers

C 1.6 Evaluate 6strategies to promotemilk consumptionamong pregnantwomen.

D. Develop policies on D 1. Impact of Lack of information Mother's choice of D 1.1 Impact of 1infant feeding code of advertisement, on the impact of Growing Up Milk promotion andprotection. labelling and promotion and (GUM) and advertisement of

packaging. advertisement on complementary food mothers' choice onconsumption of may be influenced by complementary foodGrowing Up Milk aggressive and Growing Up(GUM) and advertisement and Milk (GUM) (forcomplementary food. promotion, infomative examples mother's

labelling and attractive and child'spackaging of milk preferences of milkproducts. brand, price,

availibility and rangeof products).

D 1.2 Impact of the 2labelling andpackaging of infantformula and relatedproducts towardsinfluencing parentschoice for theirinfants and youngchild.

D 2. Impact of Lack of information Providing mother- D 2.1 Impact of 1mother-friendly on the effectiveness friendly facilities at having lactationsupport at workplace. of the implementation workplace may breaks, availability

of mother friendly support of crèche,workplace strategies breastfeeding. breastfeeding roomby Suruhanjaya at workplace and theSyarikat Malaysia duration of maternity(SSM). leave on exclusive

breastfeeding andbreastfeedingduration.

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

D 2.2 Influence of 2paid leave of motherswho adopt infant onthe success ofinduced lactation orrelactation.

D.3 Strengthening the Information on Several programmes D 3.1 Evaluate the 3current strategies/ evaluation of maternal have been effectiveness ofprogrammes/ policies strategies/ implemented over dietary guidelineson maternal, infant programmes/ the years. Hence, advice on anaemia,and young child activities in Malaysia evaluation is needed gestational diabetesnutrition. is limited. to improve the mellitus and

effectiveness of the gestational weightprogrammes. gain.

D 3.2 Evaluate the 2effectiveness of fullcream milksupplementation inthe management ofgestational weightgain.

D 3.3 Evaluate the 1effectivenessmicronutrientsupplementationprogramme (folicacid, iron, vitamin Bcomplex andvitamin C).

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References

Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., de Onis M., Ezzati, M., Mathers, C& Rivera, J. (2008). Maternal and child undernutrition: Global and regional exposures and health consequences.Maternal and Child Under Nutrition Study Group.

Cai, X.,Wardlaw, T & Brown, D.W. (2012). Global trends in exclusive breastfeeding. International Breastfeeding Journal. 7:12

Central Intelligence Agency (CIA). (2014). The World Factbook. Infant Mortality Rate.

Available https://www.cia.gov/library/publications/the-worldfactbook/rankorder/2091rank.html . Accessed on April 2015

Institute of Public Health (IPH) (2008). Infant Feeding,The Third National Health and Morbidity Survey (NHMS III) 2006. Ministryof Health, Malaysia.

UNICEF (2014). Breastfeeding.

Available http://www.unicef.org/nutrition/index_24824.html .Accessed on April 2015

WHO (2001). The optimal duration of exclusive breastfeeding: Result of a WHO Systemic review. World Health Organization, Geneva.

WHO (2004). Guiding principles for complementary feeding of breastfed child. World Health Organisations, Geneva

WHO (2005). Guiding principles for feeding non-breastfed children 6-24 months of age. World Health Organisations, Geneva

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Area 2Monitoring and Evaluation

of National Food andNutrition Security,

Nutritional Status andProgrammes

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2.0 Monitoring and Evaluation of National Food and Nutrition Security, Nutritional Status and Programmes

2.1 Introduction

Changes in the lifestyles and dietary habits of Malaysians over the last decade maybe attributed largely to socio-economic developments in the country. These changes affect the nutritional status of all age groups in the population.Reduced physical activity and unhealthy dietary lifestyle are the main contributing factors to the rising prevalenceof overweight and obesity both among children and adults (Ismail et al., 2009; IPH, 2008; MANS, 2014; NHMS2015). However, under-nutrition in the form of stunting and underweight are prevalent in Malaysia. Hence, being acountry in nutrition transition, Malaysia experiences the coexistence of the double burden of malnutrition (NCCFN,2006).

It is important that nationwide surveys on nutritional status of the population are carried out regularly to establishbaseline and updated data. Two Malaysian Adult Nutrition Surveys (MANS) (MOH, 2008 & 2014) were carried outamong adults aged above 18 to below 60 years of age. Several National Health and Morbidity Surveys have also beencarried out namely, NHMS I (1986), NHMS II (1996), NHMS III (2006), NHMS 2011 (2011) and NHMS 2015 (2015).Other large scale studies on nutritional status of preschool children (Mohd Nasir et al., 2012; Norimah et al., 2014),school children (Ismail et al., 2009; Balkish et al., 2013) have also been published. The increasing trend ofmalnutrition in the Malaysian population has imposed substantial burden on medical costs for treatment of diet-related non-communicable diseases.

While several nutrition surveys have been undertaken, there remains gaps at the national level for data on a numberof population groups. These include adolescents, infants, toddlers, pregnant women, the elderly and indigenouspopulation groups.

There is also a need to strengthen the monitoring and evaluation of national food and nutrition security, nutritionalstatus and programmes. The development and the evaluation of a national nutrition data bank and a web-basedmonitoring system are also needed for Malaysia. Some emerging needs on the behavioural and socio-economicnutrition related issues should be addressed.

A large baseline database on the nutritional status of the Malaysian population will be useful to assist relevant policymakers, stakeholders and ministries, such as the Ministry of Health, Ministry of Education, Ministry of Agricultureand Ministry of Women, Family and Community Development for developing appropriate policies and guidelines.Such a database could help the food industries to further improve the quality of their foods production and toincrease healthier food choices for the population.

More relevant studies need to be carried out to improve the nutritional status of our population. The purpose andscope of this research priority are proposed in the conceptual framework (Figure 2.1).

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2.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

A

Conduct regularlynational surveys formonitoring global/national nutrition

indicators

A1

Evaluate existing nationalnutrition programmes ofMOH/ other stakeholders

A2

Develop real time datacollection tools andanalysis for nutrition

studies

A3

Enhance MyNutriApps formonitoring and

evaluation of populationdietary intake

A4

Monitoring nationalnutritional status and

trend

B

Carry out nationalnutrition surveys on

vulnerable groups (under5 children, women ofreproductive age &

indigenous populationgroups) at regular

interval

B1

Determine national foodsand nutrition transition

over time

B2

Determination of factorsinfluencing food andnutrition security in the

food systems

C

Determine factorsinfluencing food andnutrition security

C1

Determine micronutrientintake and biomarkers

C2

Figure 2.1 : Purpose and scope of Monitoring and Evaluation of National Food and Nutrition Security, Nutritional Statusand Programmes

Monitoring and Evaluation of National Food andNutrition Security, Nutritional Status and Programmes

Strengthen monitoringand evaluation of national

food and nutritionsecurity, nutritional status

and programmes

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2.3 Table of Nutrition Research Priority Area

This NRP Area is presented in two tables. Table 2.1 presents the relative ranks for suggested topics. Appendix 2 presentsthe ranking criteria for the suggested topics in each research scope of this NRP Area.

Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

A. Strengthen A 1. Conduct regularly Lacking data on Ensuring proper A 1.1 National survey 1monitoring and national surveys for trends. planning, on the followingevaluation of national monitoring global/ implementation, scope every 5 yearsfood and nutrition national nutrition coordination, (Coordinated by thesecurity, nutritional indicators. monitoring and Institute of Publicstatus and evaluation of Health).programmes. programmes and

projects. • National Health& MorbiditySurvey (NHMS);maternal and childhealth, 2016.

• Malaysian School-Based NutritionSurvey, 2017.

• NHMS; household,2019.

• MalaysianNutrition Survey(including majorcomponent on foodsecurity), 2020.

• Nationalmicronutrientsurvey.

A 2. Evaluate existing A 2.1 National 1national nutrition evaluation of theprogrammes of MOH/ Rehabilitationother stakeholders. Programme for

MalnourishedChildren (2016).

A 2.2 National 3evaluation of SchoolMilk Programme onnutritional status ofchildren.

A 2.3 National 2evaluation of theimpact of the SchoolFeeding Programmeon nutritional statusof children.

Table 2.1: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

A 2.4. National 4evaluation of theeffectiveness of theBaby Friendly HospitalInitiative.

A 3. Develop real time A 3.1 Development of 1data collection tools real time dataand analysis for collection tools andnutrition studies. analysis for nutrition

studies.

A 3.2 Evaluation of 2acceptability, userfriendliness &practicality of realtime data collectiontools and analysis fornutrition studies

A 4. Enhance Existing Nutri apps A 4.1 Evaluation of 1MyNutriApps for only provides energy acceptability, usermonitoring and recommendation friendliness &evaluation of based on practicality ofpopulation dietary Malaysia Dietary MyNutriAppsintake. Guidelines.

A 4.2 Assessment of 2population dietaryintake using databasefrom MyNutriApps.

B. Monitoring national B 1. Carry out Lack of national level The baseline data B 1.1 National 1nutritional status and national nutritional data for suggested important for needs nutrition surveystrends. surveys of vulnerable groups: assessment and among under 5

groups (under 5 • Food intake/ decision making children.children, women at patterns process (policiesreproductive age & • Anthropometry and programmes). B 1.2 National 2indigenous group) at • Biochemical status nutrition surveysregular interval. • Socio economic among women at

status. reproductive agegroup.

To fulfill the Global B 1.3 National 3Nutriton Target by nutrition surveys of2025. indigenous population.

B 2. Determine Currently no B 2.1 Meta-analysis 1national food and database on the on food and nutritionnutrition transition of trend of food and transition of thethe Malaysian nutrition transition Malaysian population.population over time. in Malaysia.

B 2.2 Projection 2modeling on foodand nutritiontransition of theMalaysian population.

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Suggested Topicand/ or

Explanatory Notes

RelativeRank

C. Determination of C 1. Determine No compherensive The baseline data C 1.1 Effects of food 3factors influencing factors influencing data for factors on important for need price on food andfood and nutrition food and nutrition food and nutrition assessment and nutrition security.security in the food security. security. decision makingsystems. process (policies C 1.2 Effect of 2

and programmes). women empowermenton household foodand nutrition security.

C 1.3 Evaluation of the 1effects of governmentpolicies for foodproduction and tradeon nutrition securityof the population.

C 2. Determine Absence of national C 2.1 Determine 1micronutrient intake data. dietary and bloodand biomarkers. status of

micronutrients(Vitamin A, vitamin D,vitamin B1, vitamin B2,vitamin B12, folate,iron, iodine, zinc,selenium, calcium,chromium, sodium,potassium) for allage groups (nationalsurvey).

Lack of data on the C 2.2 Determination 2bioavailability of of bioavailability ofmicronutrients in local micronutrients infoods and diets. local foods and diets.

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References

Balkish MN, Siti Zuraidah M, Rashidah A, Syafinaz MS, Hatta AM, Riyanti S, Norhafizah S, Hamizatul Akmal AH (2013). Overweightamong primary school- age children in Malaysia. Asia Pac J Clin Nutr. 22(3): 408-15.

Institute for Public Health (IPH) (2008). National Health and Morbidity Survey 2006 (NHMS III): Nutritional Status. Ministry ofHealth, Malaysia.

Institute for Public Health (IPH) (2014). National Health and Morbidity Survey 2014: Malaysian Adult Nutrition Survey: SurveyFindings (Volume II). Ministry of Health, Malaysia.

Institute for Public Health (IPH) (2015). National Health and Morbidity Survey 2015: Non-Communicable Diseases, Risk Factors &Other Health Problems (Volume II). Ministry of Health, Malaysia.

Ismail MN, Norimah AK, Poh BK, Ruzita AT, Nik Mazlan M, Nik Shanita S, Roslee R & Nur Zakiah MS (2009). Nutritional status anddietary habits of primary school children in Peninsular Malaysia (2001-2002). Department of Nutrition and Dietetics, Facultyof Allied Health Sciences, Universiti Kebangsaan Malaysia.

Mohd Nasir MT, Norimah AK, Hazizi AS, Nurliyana AR, Loh SH, Suraya I. (2012). Child feeding practices, food habits, anthropometricindicators and cognitive performance among preschoolers in Peninsular Malaysia. Appetite. 58(2): 525-30.

National Coordinating Committee on Food and Nutrition (NCCFN) (2006). National Plan of Action for Nutrition of Malaysia, Ministryof Health, Malaysia.

Norimah AK, Mohd Nasir MT, Hazizi AS, Suraya I, Loh SH & Nurliyana AR (2014). Association of Body Weight Status and Socio-Demographic Factors with Food Habits among Preschool Children in Peninsular Malaysia. Mal J Nutr 20(3): 303-315.

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Area 3Life Course Food Intake

and Dietary Practices

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3.0 Life Course Food Intake And Dietary Practices

3.1 Introduction

Malaysia has experienced a rapid phase of industrialisation and urbanisation in recent decades. The rapiddemographic and nutrition transition towards achieving a developed economy status has inevitably generated markedchanges in food intake and dietary practices of the population. These changes are known to be associated withchanges in Malaysian nutritional status especially on the increased prevalence of obesity and non-communicablediseases. On the other hand, undernutrition still exists in the country. The role of nutrition has been one of the keyfactors for the improvement of population health status, particularly the decline in the incidence of malnutritionamong children. Ending hunger and malnutrition is an essential prerequisite for sustainable development indeveloping countries.

The role of nutrition across the life course has been recognised as a cornerstone of sustainable health. Nutritionalstatus trends over the years serve as an indicator of the health status of the population. The National Health andMorbidity Survey (NHMS) 1996 reported overweight and obesity among adults as 17% and 4%, respectively (IPH,1998). Ten years later, according to the NHMS 2006, the prevalence of overweight had increased substantially to 29%and obesity prevalence had increased more than three-folds to 14% (IPH, 2008).

In this conjunction, Malaysia has taken considerable concerted measures to mitigate the increase in obesityprevalence. The NHMS 2011 showed that there was only a 1.1% increase in the prevalence of adult obesity fromthe NHMS 2006 level. The success might be attributed to the intensive multi-prolonged strategies that have beencarried out to promote healthy eating habits in all age groups.

The Malaysian Adult Nutrition Survey 2014 and the Malaysia School-Based Nutrition Survey 2012 reported a verypoor intake of fruits and vegetables, milk and dairy products. Among the adolescents, 51.7% were taking less thanthe recommended two servings of fruits per day. The prevalence among adults were 85%. As for vegetable intake,93.7% of adolescents, 81.7% of adults and 91.9% of elderly did not meet the recommendation of 3 servings perday. Besides that, 81.5% adolescents and 76% of adults did not consume adequate milk and dairy products.

The NHMS 2015 reported that 27.5% of children aged 5 to 18 years old were overweight and 13.3% were obese.The nation-wide Nutrition Survey of Malaysian Children (SEANUTS Malaysia) (2012) also showed that the dietaryintakes of children aged 6 months to 12 years did not meet the Malaysian Recommended Nutrient Intakes (RNI)(MOH, 2005). More than one-third of the children did not achieve the RNI for energy, calcium and vitamin D. Almosthalf of the children (47.5%) were vitamin D insufficient. Poh et al. (2013) highlighted that inadequate intake ofcalcium and vitamin D among children should be of concern.

The severity of double burden of malnutrition among children should be given serious attention. According to NHMS2015, the prevalence of underweight, stunting and wasting among children below 5 years were 12.4%, 17.7% and8.0%, respectively. In addition, the survey also reported that the prevalence of thinness among children aged below18 years old was 7.8%.

Malaysia should align its policy and action toward achieving the goals and indicators of the Sustainable DevelopmentGoals (SDGs) adopted by the United Nations Summit in September 2015. Specifically, in the context of addressingfood intake and nutritional status, the Zero Hunger (Goal #2) and Good Health and Well-being (Goal #3) goals shouldbe monitored. The indicators of these two goals namely, the prevalence of undernourishment and prevalence ofmoderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES) (Goal#2), as well as the indicators on stunting, wasting and overweight among children under 5 years of age (Goal #3)will be monitored for this NRP Area.

The framework for the purpose and scope for this NRP is shown in Figure 3.2. The main focus is on theunderstanding food intake and dietary practices among various age groups. In this respect there is a need to assessthe impact of nutrition on healthy growth and development. More researches are needed on nutrition relatedbehaviour among various age groups and the variability in individuals in response to diet and food intakes.

The second focus of this NRP Area is on evaluating the effectiveness of interventions to promote healthy dietarypractices among various age groups. Several interventions have been carried out by government agencies, howevertheir effectiveness have not evaluated. To keep up with advances in technology, interventions should employ availabletechnology to reach the community.

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Another focus of this NRP Area is on understanding the consequences of unhealthy dietary practices on healthstatus in later life. There are limited studies in Malaysia on the effects of unhealthy dietary practices in later stagesof life. Concerns in this respect is focus on excess intake of sugar, salt, fats coupled with low intake of fruits andvegetables in the population.

3.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

To understand foodintake and dietary

practices among variousage groups

A

Impact of nutrition onhealthy growth and

development

A1

Determination ofenvironmental and

societal factors affectingfoods and nutrition

A2

Determination of foodchoice behaviour ofvarious age groups

A3

Evaluation of variability inresponses to diets and

food intake

A4

Effective strategies/programmes to promotehealthy dietary practicesamong various age

groups

B

Identification of effectiveinterventions to promotehealthy dietary practicesamong various age

groups

B1

To understand theconsequences ofunhealthy dietary

practices on health statusin later stages of life

C

Determination on theconsequences ofunhealthy dietary

practices of various agegroups

C1

Identification of underand over nutrition and theeffect on health status in

later stages of life

C2

Figure 3.1 : Purpose and scope of life course food intake and dietary practices.

Life Course Food Intake and Dietary Practices

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3.3 Table of Nutrition Research Priority Area

The NRP Area is presented in two tables. Table 3.1 presents the relative ranks for suggested topics. Appendix 3presents the ranking criteria for the suggested topics in each research scope of this NRP Area.

Purpose Research Scope Research GapsSuggested Topic

and/ orExplanatory Notes

RelativeRank

A.To understand the A 1. Impact of Lack of information on A 1.1 To determine contribution of optimal 1food intake and dietary nutrition on healthy the roles of diet and nutrition to growth and cognitive development.practices among growth and food components onvarious age groups. development. normal growth and A 1.2 To identify markers (subjective and 2

development among functional) for assessing healthy childMalaysian. development.

A 1.3 To assess dietary intake of palm oil and 3palm oil products among Malaysia of all agegroups.

A 2. Determination of 1) Lack of studies/ A 2.1 Effects of social and economic changes 2environmental and information on the as part of modernisation on food intakesocietal factors relationship between among Malaysians across the life course.affecting foods and nutrition andnutrition. Malaysian A 2.2 Differences in dietary practices among 6

environment. various cultures in Malaysia.

2) To support human A 2.3 Socio-cultural factors influencing intake 1nutrition policies that of fast food and convenient food amongimpact short and long various age groups.term nutritionoutcomes. A 2.4 Socio-cultural and environmental factors 4

influencing eating out and late night eatingpractices.

A 2.5 To assess factors influencing food 5choices and eating behaviour among variousage groups.

A 2.6 To examine environmental factors that 3affect dietary practices.

A 2.7 To determine socio-cultural determinants 6of food habits.

A 3. Determination of Lack of data between A 3.1 To identify gaps and barriers on practising 2nutrition-related behaviour and food healthy eating.behaviour of various choices amongage groups. Malaysians. A 3.2 To determine psycho-social factors 3

influencing food choices of various age groups.

A 3.3 To determine the influence of food 1marketing on food decision-making amongchildren and adolescents.

A 4. Evaluation of Limited information on A 4.1 To study nutrigenetics and nutrigenomics 2variability in responses metabolic responses in relation to diet among ethnic groups,to diets and food to diets and food especially in children and adolescents.intake. among Malaysians.

A 4.2 To determine metabolic responses to 4diet and food intake across the life course.

Table 3.1: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Research GapsSuggested Topic

and/ orExplanatory Notes

RelativeRank

A.4.3 The role of genetically modified foods as 1part of a healthy dietary intake.

A.4.4 To develop nutrigenomics-based 3personalised nutrition intervention programmes.

B. Effective strategies/ B 1. Identification of B 1.1 To identify training needs to protect 1programmes to effective interventions children against inappropriate marketing onpromote healthy to promote healthy unhealthy food.dietary practices dietary practicesamong various age among various age B 1.2 To evaluate the impact of the integration 10groups. groups. of nutrition components into''Kebun Dapur

Project'' in improving dietary awarenessamong preschool and school children.

B 1.3 To evaluate the feasebility of providing 6healthy school meal to improve dietarypractices among school children.

B 1.4 To evaluate the impact of the “School 9Meal Programme” in selected schools toimprove dietary practices among schoolchildren.

B 1.5 Meta-analysis of the effectiveness of hard 3policies approach in transforming dietarypractices of the population.

B 1.6 To evaluate the impact of providing 6healthy food choices at work place, school,colleges, institutions on dietary practices.

B 1.7 To identify the effectiveness of community 4empowerment strategies in promoting healthyeating among various age groups.

B 1.8 To identify effective strategies to reduce 5salt intake among Malaysians.

B 1.9 To determine factors affecting fruits and 6vegetable intakes among Malaysian of variousage groups.

B.1.10 To identify effective strategies to reduce 6sugar intake among Malaysians.

B 1.11 To evaluate the effectiveness and 3acceptance of web-based nutrition education.

B 1.12 To identify innovative strategies in 9promoting healthy eating among various agegroups.

B 1.13 To evaluate the effectiveness of food- 4based educational tools to promote healthyeating among Malaysians.

B.1.14 To identify the effectiveness of social 5media in promoting nutrition to various agegroups.

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Purpose Research Scope Research GapsSuggested Topic

and/ orExplanatory Notes

RelativeRank

B 1.15 To develop nutrient profiling models for 9Malaysian foods.

B 1.16 To identify effective strategies to 8promote milk consumption among children.

B 1.17 To conduct cost-effective analysis on 3selected nutrition programmes.

C. To understand the C 1. Determination on Limited information/ C 1.1 Sugar-sweetened beverages consumption 4consequences of the consequences of studies on the among Malaysians.unhealthy dietary unhealthy dietary consequences ofpractices on health practices of various unhealthy dietary C 1.2 Salt intake among Malaysians 2status in later stages age groups. practices on healthof life. status in later life. C 1.3 Milk consumption among various age 5

groups.

C 1.4 Effects of marketing of unhealthy foods 2on dietary practices among children andadolescents.

C 1.5 Factors affecting fruit and vegetable 1intakes among Malaysian of various agegroups.

C 1.6 To determine dietary patterns and effects 3on health outcomes.

C 2. Identification of Limited information/ C 2.1 Determine association between macro 3under and over studies on the and micronutrient intake and health outcomesnutrition and the effect consequences of in later stages of life.on health status in unhealthy dietarylater stages of life. practices on health C 2.2 Effects of early childhood over-nutrition 2

status in later life. on morbidity and mortality.

C 2.3 To investigate lifestyles, dietary habits 1and risk factors among children, adolescentsand adults.

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References

Institute for Public Health, IPH (1998). National Health and Morbidity Survey 1997 (NHMS II): Nutritional Status. Ministry of Health,Malaysia.

Institute for Public Health, IPH (2008). National Health and Morbidity Survey 2006 (NHMS III): Nutritional Status. Ministry of Health,Malaysia.

Institute for Public Health, IPH (2013). National Health and Morbidity Survey 2012: Malaysia School-Based Nutrition Survey. Ministryof Health, Malaysia.

Institute for Public Health, IPH (2014). National Health and Morbidity Survey 2014: Malaysian Adult Nutrition Survey: FoodConsumption Statistics of Malaysia (Volume III). Ministry of Health, Malaysia.

Institute for Public Health, IPH (2015). National Health and Morbidity Survey 2015: Non-Communicable Diseases, Risk Factors &Other Health Problems (Volume II). Ministry of Health, Malaysia.

Poh BK, Ng BK, Siti Haslinda MD, Nik Shanita S, Wong JE, Budin SB, Ruzita AT, Ng LO, Khouw I, Norimah AK (2013). Nutritionalstatus and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children(SEANUTS Malaysia). British Journal of Nutrition. 110, S21–S35

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Area 4Macro and MicronutrientExcesses and Deficiencies

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4.0 Macro And Micronutrient Excesses and Deficiencies

4.1 Introduction

Malaysia faces the double burden of both undernutrition and overnutrition challenges. While protein-energymalnutrition and micronutrient deficiency persist in low-income and indigenous populations, prevalence ofoverweight children, especially from urban areas, is growing, and obesity among adults continues to increase (IPH,2015). Hence, micronutrient deficiency is a key contributor to malnutrition and associated ill health throughout theworld. It is described as the hidden hunger as it often goes unnoticed, even by those affected (Bailey, West andBlack, 2015). Consequences of subclinical forms of micronutrient deficiencies are far reaching, affecting physicalgrowth and causing problems with immunological and cognitive maturation that may be irreversible. Micronutrientdeficiencies also lead to birth defects, blindness, as well as decreased school and work performance (Downs, 2016).

In Malaysia, much has been done in addressing micronutrient deficiency problems of “old”. Nontheless, suchmicronutrient deficiencies persist such as iron deficiency in young children, female subjects of reproductive age andthe elderly; iodine deficiency particularly among Orang Asli women, and mild subclinical vitamin A deficiency in ruralchildren (NCCFN, 2016). Hence, gaps in knowledge and cost-effective intervention strategies remain to be explored(Allen, 2014).

At the same time, there is a paucity of information on other micronutrient deficiencies that are on the rise worldwide,such as deficiency of zinc, selenium, folate and vitamin D. Hypovitaminosis D is extensively reported globally(Cashman et al., 2016). In Malaysia, studies have shown that, despite the abundance of sunshine throughout theyear, insufficiency vitamin D occurs in children and adults (Poh et al., 2013). Health consequences of poor vitaminD status include osteoporosis (coupled with low calcium intake) and increased risks of other chronic diseases, suchas diabetes and some cancers.

In light of the current nutritional situation in Malaysia, the framework for the purpose and scope for the ResearchPriority Area on macro and micronutrients have been developed as shown in Figure 4.1. The focus is to strengthenepidemiological understanding of the extent of micronutrient deficiencies in the country. In this respect, there is aneed to carry out a national assessment on the prevalence of dietary intake and blood status of micronutrientdeficiencies of all age groups. The rationale is to develop a sound data base on micronutrient status and to establishits association with health outcomes.

Another focus of this research priority is evaluating the impact of current nutritional strategies and developing otherstrategies, including fortification to improve micronutrient status. The primary programme of the Ministry of Healthis supplementations of iron, folic acid and multivitamins for pregnant women. The effectiveness of food supplementprogrammes should be evaluated periodically. While the use of micronutrient supplements serves as an importantapproach towards the alleviation of malnutrition in specific conditions, the long term solution of micronutrientdeficiency lies in food-based interventions. These include use of innovative methods to tap on indigenous foods assources of micronutrients.

The third focus of this research area is enhancing current delivery systems to improve intervention strategiesreaching deserving target subjects. Intervention efforts should be intensified especially among the poor in rural andurban areas. Innovatives technologies to target population groups should be used to track target groups and ensuredelivery of intervention and programmes.

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4.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

Strengthenepidemiological andclinical understanding

A

Assessment ofassociation between

macro and micronutrientstatus with health

outcomes

A1

Develop and evaluateappropriate studies andintervention strategies

B

Evaluation of currentintervention strategies onmacronutrient intake and

status

B1

Evaluation of currentintervention strategies onmicronutrient intake and

status

B2

Development of novelstudies and strategies toimprove macro and

micronutrient status of allage groups

B3

Figure 4.1 : Purpose and scope of macro and micronutrient excesses and deficiencies.

Macro and Micronutrient Excesses and Deficiencies

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4.3 Table of Nutrition Research Priority Area

This NRP Area is presented in two tables. Table 4.1 presents the relative ranks for suggested topics. Appendix 4presents the ranking criteria for the suggested topics in each research scope of this NRP Area.

Purpose Research Scope Nutrients Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

A. Strengthen A 1. Assessment of Assess micronutrients Lack of data for policy A 1.1 Determine 2epidemiological and association between status of various age and programmes. association betweenclinical understanding. macro and groups in terms of micronutrient intake

micronutrient status dietary intake and and health outcomeswith health outcomes. blood/ urine (obesity, diabetes,

concentration: hypertension,stunting).

vitamin A,vitamin D, vitamin B1, A 1.2 To asesss 1vitamin B2, impact ofvitamin B12, folate, micronutrient statusiron, iodine, zinc, on growth andselenium, calcium, cognitive developmentchromium, sodium, of children.potassium.

B. Develop and B 1. Evaluation of Lack of data at the B 1.1 To identify 1evaluate appropriate current intervention national level. effective strategies forstudies and strategies on the prevention andintervention macronutrient intake controlling ofstrategies. and status. macronutrient

deficiency in all agegroups.

B 2. Evaluation of Folic acid, iron, Lacking data on B 2.1 Scale up 1current intervention vitamin C, vitamin B haematinic nutrition interventionstrategies on complex supplementation in towards weeklymicronutrient intake (haematinics). pregnancy: haematinicand status. supplementation

1. Compliance by among pregnantmothers. women.2. Cost effectivenessof supplementation B 2.2 Undertake cost 2programme. effectiveness study of

haematinicsupplementationamong pregnantwomen and femaleadolescents.

B 2.3 Relationship 3between LBW withmaternal micronutrientstatus.

Iodine Increasing findings of B 2.4 Determine 4congenital effectiveness ofhypothyroidism in Universal Saltinfants in Peninsular Iodisation (USI)Malaysia. Lacking among pregnantdata on maternal mothers betweeniodine status. gazetted and non-

gazetted areas.

Table 4.1: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Nutrients Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

B 3. Development of Sodium and Lack of national data B 3.1 Conduct 7novel studies and potassium. on sodium and interventions towardstrategies to improve potassium intake and reducing sodium andmacro and health risk. increasing potassiummicronutrient status intake.of all age groups.

Iron, folate Lacking data on iron B 3.2 Conduct 6and folate status intervention studies of(intake and blood) of iron and folic acidfemale adolescents. supplementation on

female adolescent.

Need data for B 3.3 Determine 5effectiveness of wheat pre and postflour fortification. fortification of iron

and folate status.

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References

Allen LH. (2014). Micronutrient Research, Programs, and Policy: From Meta-analyses to Metabolomics. Adv. Nutr. 5: 344S–351S.

Bailey RL, West KPJr, Black RE (2015). The Epidemiology of Global Micronutrient Deficiencies. Ann Nutr Metab 66(suppl 2):22–33

Cashman KD, Dowling KG, Skrabáková Z, Gonzalez-Gross MG et al., (2016). Vitamin D deficiency in Europe: pandemic? Am J ClinNutr doi: 10.3945/ajcn.115.120873.

Downs S (2016). The Multiple Burdens of Malnutrition. Food system drivers and solutions. Life and Sight 30(1); 41-46.

Institute for Public Health (IPH) 2015. National Health and Morbidity Survey 2015 (NHMS 2015). Volume II: Non-CommunicableDisease, Risk Factors and Other Health Problems; 2015.

National Coordinating Committee on Food and Nutrition, Ministry of Health Malaysia (2016). The National Plan of Action forNutrition of Malaysia (NPANM) III, 2016-2025. MOH, Putrajaya, Malaysia.

Poh BK, Ng, BK, Siti Haslinda MD, Nik Shanita S et al., (2013) Nutritional status and dietary intakes of children aged 6 months to12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). Brit J Nutr 110, S21–S35

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Area 5Overweight and Obesity

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5.0 Overweight and Obesity

5.1 Introduction

Obesity is a complex systemic, multi-causal and chronic problem globally, Figure 5.1 (Foresight Report, UK (2007).The science on obesity and research into how to reverse this growing health burden is by no means complete. Theescalation of obesity in Malaysia, once thought to be an urban phenomenon, has now spread to the rural populationat an alarming rate. As Malaysia progresses rapidly towards a developed economy status, the health of its populationwill likely continue to deteriorate (Ismail et al., 2002). The recent WHO report put Malaysia as number 1 in SoutheastAsia and number 6 in Asia in terms of obesity prevalence. The WHO (2015) report revealed that in less than ageneration, rates of obesity have risen dramatically worldwide and in the last decade has seen many developingeconomies like Malaysia rapidly catching up. The prevalence of obesity follows a socio-economic gradient. For manycountries including Malaysia the burden is greater with affluence, however with globalization we have witness achange from traditional diets and lifestyle to more westernized models thus shifting a greater burden of obesity toboth the higher to lower socio-economic groups. Addressing obesity problem is thus a compelling logic.

Figure 5.1: Complexity in tackling Obesity (Foresight Report, UK (2007)

Changes in dietary habits and sedentary lifestyles are known to be associated with changes in health and increasedprevelance of chronic disease such as type 2 diabetes, cardiovascular diseases, hypertension and certain cancers(WHO, 2000). It also drastically reduces quality of life and is costly in terms of absence from work and use of healthresources besides posing numerous psychosocial problems such as depression, lowered self esteem, jobdiscrimination and other form of social stigmatization (WHO, 2000).

In Malaysia, the nutritional status of pre-school children which covers 5-6 years old showed a similar pattern withthe under-five. Findings from NHMS 2006 showed 73.3% of children which are classified as normal weight and ithad reduced to 68.2% in NHMS 2015. Based on the national surveillance study of the NHMS 2011, about 6.5% youngchildren aged <5 years and 6.0% children and adolescents aged between 5 to <18 years were classified as overweight(BMI-for-Age >+2SD). Two big surveys involving more than 10,000 primary school children aged 7-12 yearsconducted in 2002 and 2008 (Ismail et al., 2009) showed increased prevalence in overweight from 11.0% to 12.8%and obesity from 9.7% to 13.7%, respectively.

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Available data for adult also suggest that prevalence of overweight and obesity in Malaysia over the last decade hasmatched that of some developed countries. The Second National Health Morbidity Survey (NHMS II) in 1996 (IPH1998) reported a prevalence of 17% overweight and 4% obesity in adults, while the NHMS III conducted in year 2006(IPH 2008) revealed an increase of overweight and obesity to 29% and 14% respectively.The NHMS (2011) reportindicated the prevalence have somewhat stablised at 29.4% and 15.1%, while the more recent NHMS (2015) reportrevealed an increase to 30% and 17.7%, respectively, suggesting that 1 in 2 adult Malaysians are either overweightor obese.

The overall trend of overweight and obesity among Malaysians from various age groups from 2006 to 2011 hasincreased slightly with the Indians and Malays showing the highest prevalence. For abdominal obesity, about 51.8%adults aged 18 years and above were at risk of abdominal obesity.

As Malaysia progresses rapidly towards being a developed economy, a national strategy needs to be in place tohelp prevent, treat and manage obesity. Obesity research in Malaysia is very much in its infancy. A review on obesityresearch done over the years by panel of experts of the Obesity Task Force, chaired by Deputy Director General ofHealth, revealed that hardly any is critical enough to be used as evidence-based studies. What is lacking are “hard”facts to help policy makers to argue their case and provide workable strategies in combating obesity in Malaysia. Itis therefore imperative that a multi-disciplinary programme with projects that has not been carried out before besupported in order to improve our understanding on how to reduce the escalation of this rising epidemic.

Figure 5.2 present the conceptual framework on the scope of the research priority areas for obesity in Malaysia. Itcovers three general areas, namely improvement in understanding the problems related to overweight and obesity,improvement in the effectiveness of obesity prevention and management, and development of new modalities inrelation to the effectiveness of obesity prevention and management, and development of new modalities in relationto the diagnosis and treatment of overweight and obesity.

To help us further improve our understanding on obesity, two sub-topics were identified, namely epidemiology,which includes determining prevalence of obesity in the population as well as the risk factors, obesity and co-morbidities and early nutrition adult adiposity while the etiology, specifically focus on dietary intake in relation toappetite control, socio-cultural aspects of eating behaviour and dieting; metabolic susceptibility; physical activity;and the genetics of obesity. There is also a dire need to evaluate the economic and social costs of overweight andobesity in Malaysia.

The scope for ‘improving effectiveness’ of obesity programmes covers both the prevention and intervention aspects,as well as management of obesity. We also need to address policies options related to the “obesogenic” environmentwe live in.

The scope for ‘development of new modalities’ covers diagnosis of overweight and obesity, and treatment methods,including herbal, functional foods, and other novel and practical intervention strategies.

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Figure 5.2: Purpose and scope of overweight and obesity

5.2 Conceptual Framework on The Purpose and Scope for Research Priority Area

Improve understandingon the epidemiology of

obesity

A

Determination ofBMI and WC cut-offs for

Malaysians

A1

Relationship betweenadiposity and

cardiovascular riskfactor

A2

Impact of early nutritionon development of adult

obesity

A3

Impact of obesity toeconomic and social cost

in Malaysia

A4

Association of dietaryintake, appetite control

and eating behaviour withobesity in Malaysia

A5

Determination of socio-cultural factors

influencing obesity

A6

Effect of metabolicpredisposition to onset of

obesity

A7

Association betweensedentary lifestyle and

obesity

A8

Determination of geneticfactors influencingdevelopment of

overweight and obesity

A9

Improve effectiveness ofintervention and

management of obesity

B

Development andevaluation of obesity

prevention andintervention

B1

Development andevaluation of obesity

management

B2

Impact of policies andenvironment on obesity

B3

Developing newmodalities

C

Identification of methodto define obesity

C1

Identification of novelstrategies to prevent

obesity

C2

Overweight and Obesity

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5.3 Table of Nutrition Research Priority Area

The NRP Area is presented in two tables. Table 5.1 presents the relative ranks for suggested topics. Appendix 5presents the ranking criteria for the suggested topics in each research scope of this area.

Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

A. Improve A 1. Determination of Waist circumference A 1.1 Definition of BMI cut-offs for Malaysians 3understanding on the BMI and WC cut-offs is an important based on body fat compositions.epidemiology of for Malaysians. indicator of centralobesity. obesity. Cuts-offs for A 1.2 Cohort study to identify appropriate of 2

waist circumference BMI cut-offs for Malaysians based on co-of adults are known, morbidities.but not for childrenand adolescents. A 1.3 Identify appropriate of WC cut-offs for 1

Malaysian adults based on co-morbidities.

A 2. Relationship There is lack of A 2.1 Relationship between body composition 1between adiposity sufficient data and and morbidity in adult Malaysians.and cardiovascular the consequence ofrisk factor. higher body fat in A 2.2 Relationship between body composition 2

Malaysian has not and health risks in children and adolescents.been scientificallyestablished.

A 3. Impact of early Defining early A 3.1 To establish appropriate growth standard 2nutrition on predictors of obesity chart from birth to adulthood in order to definedevelopment of adult in Malaysia is the normal age-range for onset of adiposityobesity. important, as rebound of healthy children in various ethnic

premature age of groups in Malaysia (cohort study).adiposity reboundand catch-up growth A 3.2 To define which pediatric population 2(after foetal, neonatal groups are at risk to show neonatal or post-and infant growth natal catch-up growth.retardation) haverepeatedly been A 3.3 The relationship between gestational 1shown to be strong weight gain and breastfeeding practices on thedeterminants of later development of obesity.obesity.

A 4. Impact of obesity Economic cost of A 4.1 The economic and personal health costs 1to economic and obesity in Malaysia of overweight and obesity.social cost in need to be assessedMalaysia. as increased cost of A 4.2 The economic burden of obesity and 1

obesity-related obesity-related chronic diseases.healthcare thatMalaysia can illafford.

Obesity has a A 4.3 Psycho-socio-cultural determinants of 2significant impact on quality of life in obese population.health-related qualityof life and functional A 4.4 Psychosocial problems related to obesity 1capacity of individual among children in schools.in the society

A 4.5 Childhood obesity, educational 3trajectories and school failure.

Table 5.1: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

A 5. Association of Appetite control A 5.1 Effects of fatty acids on appetite control. 7dietary intake, appetite studies have nevercontrol and eating been reported in A 5.2 Effects of proteins and amino acids on 7behaviour with obesity Malaysia. There is a appetite control.in Malaysia. need to understand

the effect of palm- A 5.3 Investigation on appetite biomarkers 7based oil and fats, among obese children.as well as protein, onappetite control.

Eating behaviour A 5.4 Night eating behaviour and syndrome and 1especially higher its relationship with obesity.consumption duringnight-time and dieting A 5.5 Energy intake regulation among shift 5may affect energy worker.intake. Psychologicalmechanisms A 5.6 Identification of psychological 3influencing eating mechanisms influencing eating behaviour.may help maintainappropriate body A 5.7 Relationship between stress and eating 3weight gain. behaviour.Improper weight lossmethods may lead to A 5.8 Weight loss methods being practised by 4yoyo effect on body Malaysian population.weight.

A 5.9 Dieting behaviour and body weight of 6adolescents and young adults.

A 5.10 The role of diet composition on body 2weight - (relevant food database: sugar, fattyacids, prepared meals/cooked foods, fastfoods, international cuisine).

A 6. Determination of Public perception of A 6.1 Parental perception of childhood obesity 3socio-cultural factors health in relation toinfluencing obesity. obesity influences the A 6.2 Food cultures and socio-cultural 1

success of obesity determinants of foodhabits (including nativeprevention and minorities).management.

A 6.3 Socio-cultural determinants of body 3image.

A 6.4 Inter-disciplinary approach to decision 2making in food and nutrition (nutritionsociology, anthropology and psychology).

A 6.5 Obesity at workplace, stigmatization, well 3being and productivity.

A 6.6 Understanding babies born SGA and its 1effects on obesity, metabolic syndrome,hypertention, insulin resistance and diabetes.

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

A 7. Effect of Identification of A 7.1 Metabolic predisposition to adult-onset 1metabolic individuals who are of obesity.predisposition to prone to obesity isonset of obesity. important as there is A 7.2 Metabolic predisposition to childhood- 1

poor prognosis for onset of obesity.the success of long-term management ofobesity.

A 8. Association With the advent of A 8.1 Effect of working hours on opportunity 4between sedentary technological for physical activity and exercise.lifestyle and obesity. advances, Malaysians

lead a sedentary A 8.2 Survey of existing physical activity 6lifestyle and curriculum and co-curriculum programme inconsequently higher schools.rates of obesity. Thereis a need for in depth A 8.3 Assessment of physical activity level in 5understanding of the relation to obesity (including objectivecurrent situation and methods).factors affectingphysical inactivity. A 8.4 Factors influencing physical activity level 3

in adults and older adults.

A 8.5 Factors influencing physical activity level 3of children and adolescents.

A 8.6 Sedentary behaviour and obesity 2

A 8.7 Physical activity, sedentary behaviour 3and physical fitness in overweight and obese.

A 8.8 Using Geographic Information Systems 1(GIS) to show trends in obesity (includingfitness center, recreational center and 24hours food outlet).

A 8.9 Relationship between sleeping pattern 4and obesity in all age group.

A 9. Determination of Genes and the A 9.1 The genetics of childhood obesity. 2genetic factors environment interactinfluencing to influence A 9.2 Determination of heritability of obesity- 2development of development of related phenotypes.overweight and overweight andobesity. obesity. To date, there A 9.3 Phenotyping of eating behaviour and 1

is no known study food intake.in this area carriedout in Malaysia.

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

B. Improve B 1. Development and In dealing with B 1.1 Development and evaluation of school- 3effectiveness of evaluation of obesity inequalities in health based behavioural intervention programmesintervention and prevention and status as a for the prevention of overweight in children.management of intervention. fundamental principleobesity. of public health, it is B 1.2 Development, implementation and 3

necessary to consider assessment of the effectiveness of appropriatethe specific issues obesity intervention programmes in schools.which make particulargroups more B 1.3 Effectiveness of existing nutrition and 5vulnerable to weight physical activity curriculum and co-curriculumgain. There is a lack of programme in schools.available model for theprevention and B 1.4 Evaluation of best practices in workplace 3intervention of obesity. and institutional for obesity prevention and

treatment.

B 1.5 Effectiveness of existing obesity 1intervention programmes to reduce prevalenceof diabetes, hypertention and cardiovasculardisease in community (i.e.: KOSPEN iniatitive.Jom Mama & MyBFF).

B 1.6 Effectiveness of park-based obesity 6prevention and management programme.

B 1.7 Evaluation on the effectiveness of the 5media campaign to prevent obesity.

B 1.8 Impact of television advertising of foods/ 4beverages high in fat and/or high in sugar inchildhood obesity.

B 1.9 Cost effectiveness of obesity prevention 2and/ or intervention programmes.

B 2. Development and Success rate of the B 2.1 Effectiveness of drugs and supplements/ 2evaluation of obesity various approaches to herbs in obesity management.management. obesity management

is low, and as such B 2.2 Development and evaluation of behavior 1there is a need to modification strategies for management ofdevelop more practical obese adults/ children.and effectiveapproaches. B 2.3 Development and evaluation of strategies 1

for promotion of weight loss and weightmaintenance, and prevention of weight regain.

B 2.4 Effectiveness of health education in 2managing obesity and its co-morbidities.

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

B 3. Impact of policies There is lack of data B 3.1 Determination of political and macro 1and environment on on the impact of sociological factors that contribute toobesity. policies and the overweight and obesity in the population.

environment onobesity. To prevent B 3.2 Evaluation of the feasibility of providing 5and manage obesity, incentives to employees that support healthgovernments, food eating habits and active lifestyle.industries, the media,communities and B 3.3 The role of food industry advertising and 3individuals need to broadcasting agencies towards healthy eatingwork together to and obesity prevention.modify theenvironment so that it B 3.4 The role of restaurants and food service 3is less conducive to industries towards healthy eating and obesityweight gain. prevention.

B 3.5 Effectiveness of food service and 4restaurant empowerment programme onobesity prevention and management.

B 3.6 The impact of built environment on 3physical activity and obesity prevention.

B 3.7 The ‘obesogenic’ environment and its 3effects on dietary intake and obesity.

B 3.8 Compliance of food service providers 5towards existing guidelines.

B 3.9 Socio-cultural determinants of the 5reception of public health and nutritionmessages by subpopulation in order to developtarget policies.

B 3.10 Agriculture subsidies on food 6production and supply as well as cost andconsumption pattern on development ofobesity.

B 3.11 Identification of environmental factors 2that can be changed to improve physicalactivity levels.

B 3.12 Association between use of Sugar 4Sweetened Beverages (SSB) and childhoodobesity prevalence.

B 3.13 Effects of sugar subsidies removal with 3obesity prevalence.

C. Developing new C.1 Identification of Obesity has C 1.1 Identifications of other indices to define 1modalities. method to define traditionally been obesity.

obesity. defined based onBMI cut-offs.However, it is knownthat BMI does nottruly reflect bodycomposition.

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

C 2. Identification of Functional foods and C 2.1 Identification of foods rich in specific 2novel strategies to herbal traditional ingredients (e.g. specific fatty acids, otherprevent obesity. medication have been phytochemicals) that can stimulate

used for the thermogenesis and fat oxidation polyphenolsprevention and (assessed by indirect calorimetry) as well astreatment of obesity. improve glucose tolerance (assessed byHowever, there has OGTT).been no scientificevidence on the C 2.2 Identification of local bioactive food 4efficacy and safety. ingredients.

Novel and practical C 2.3 Comparison on the effectiveness of 3intervention strategies different methods of weight reduction forare important for the obese individuals.treatment of obesity.

C 2.4 Randomized Control Trials of obesity 1prevention programmes (individual/ group).

C 2.5 Psyco sociological and nutritional 2management and assessment of bariatricsurgery for obese subjects.

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References

Bryony Butland, Susan Jebb, Peter Kopelman, Klim McPherson, Sandy Thomas, Jane Mardell, Vivienne Parry (2007). TacklingObesities: Future Choices –Project Report. London: Foresight Programme of the Government Office for Science.

Foresight Report UK (2007). Tackling Obesities: Future choices- Project Report. 2nd Edition, Government Office for Science (UK),pp161.

Institute for Public Health, IPH (1998). National Health and Morbidity Survey 1996 (NHMS II): Nutritional Status. Ministry of Health,Malaysia.

Institute for Public Health, IPH (2008). National Health and Morbidity Survey 2006 (NHMS III): Nutritional Status. Ministry of Health,Malaysia.

Institute for Public Health, IPH (2011). National Health and Morbidity Survey 2011: Non- communicable Diseases (Volume 2).Ministry of Health, Malaysia.

Institute for Public Health, IPH (2015). National Health and Morbidity Survey 2015: Non-Communicable Diseases, Risk Factors &Other Health Problems (Volume 2). Ministry of Health, Malaysia.

Ismail MN, Chee SS, Nawawi H, Yusoff K, Lim TO, James WPT (2002). Obesity in Malaysia. The International Association for theStudy of Obesity. Obesity Reviews .3, 203–208

Ismail MN, Norimah AK, Poh BK, Ruzita AT, Nik Mazlan M, Nik Shanita S, Roslee R & Nur Zakiah MS (2009). Nutritional status anddietary habits of primary school children in Peninsular Malaysia (2001-2002). Department of Nutrition and Dietetics, Facultyof Allied Health Sciences, Universiti Kebangsaan Malaysia.

WHO (2000). Health Systems: Improving Performance. World Health Organisations, Geneva

WHO (2002). Reducing Risks, Promoting Healthy Life. World Health Organisations, Geneva

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Area 6Diet Related Non-

Communicable Diseases(Cancer, Diabetes and

CardiovascularDisease)

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6.0 Diet Related Non-Communicable Diseases (Cancer, Diabetes and Cardiovascular Disease)

6.1 Introduction

6.1.1 Burden of Non-Communicable Diseases

Non-communicable diseases (NCDs) are chronic diseases, that do not have a specific disease-causing agent,are of long duration and generally progress slowly. The four main types of NCDs are cardiovascular diseases(including coronary heart disease and stroke), diabetes, cancers and chronic respiratory diseases (such aschronic obstructed pulmonary disease and asthma). Prevalence of NCDs have reached epidemic proportionsand are the leading global causes of death. The Global Health Observatory Data (WHO, 2015) estimated theleading causes of NCD deaths in 2012 were cardiovascular diseases (17.5 million deaths, or 46% of all NCDdeaths), cancers (8.2 million, or 22% of all NCD deaths), and respiratory diseases, including asthma andchronic obstructive pulmonary disease (4.0 million) while diabetes caused 1.5 million deaths. Nearly 80%of these deaths occurred in low and middle income countries. Bloom et al. (2011) projected that by 2030NCDs will cause an estimated USD17.3 trillion of cumulative economic loss from healthcare expenditures,reduced productivity and lost capital, worldwide (Mozaffarian, 2016).

In Malaysia for the year 2008, the total burden of disease among Malaysians was 2.85 million according toDisability Adjusted Life Years (DALYs). About 75% of this burden was attributable to NCDs (Group II) asillustrated in Figure 1 followed by communicable diseases (Group I) and injury (Group III) (IPH, 2012).Ischemic heart diseases and Cerebrovascular diseases contributed to 27.1% and 26% of premature mortalityin male and female respectively in 2008 (IPH, 2012). Ischemic heart disease and cerebrovascular diseaseconstituted the highest percentage of the top 10 causes of burden of disease (DALYs), in Malaysia, in 2008(Table 2) (IPH, 2012).

The Malaysian National Health and Morbidity Survey (NHMS) indicated that for adults, the prevalence ofdiabetes mellitus had increased in the space of ten years from 11.6% in 2006, to 17.5% in 2015. The twomajor risk factors for cardiovascular diseases, which are hypertension and hypercholesterolemia, alsoshowed an increasing trend from 2006 to 2015. Prevalence of hypertension slightly had decreased from32.2% in 2006 to 30.3% in 2015. While the prevalence of hypercholesterolemia had doubled from 20.7%in 2006 to 47.7% in 2015.

In view of the increasing burden of NCDs in Malaysia, the Ministry of Health (MOH) has implemented variousmeasures including the National Strategic Plan for Non-Communicable Diseases (NSP-NCD) and the NationalPlan of Action for Nutrition of Malaysia.

Group ICommunicable, maternal, perinatal and nutritional conditions.

Group IINon-communicable diseases

Group IIIInjuries

8%17%

75%

Figure 6.1: Disability Adjusted Life Years (DALYs) by major disease groups, Malaysia, 2008

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Table 6.1: Top 10 causes of premature mortality (YLLs), Malaysia, 2008

Rank DiseaseMales

DALYs %Disease

Female

DALYs %

1. Ischemic heart disease 173,040 18.8 Ischemic heart disease 85,192 14.3

2. Road traffic injuries 104,259 11.4 Cerebrovascular diseases (Stroke) 69,571 11.7

3. Cerebrovascular diseases (stroke) 76,123 8.3 Breast cancer 33,029 5.6

4. Lower respiratory infections 37,688 4.1 Lower respiratory infections 25,698 4.3

5. HIV 30,457 3.3 Road traffic injuries 20,847 3.5

6. Trachea, bronchus and lung cancers 28,640 3.1 Nephritis and nephrosis 18,940 3.2

7. Nephritis and nephrosis 21,974 2.4 Trachea, bronchus and lung cancers 16,739 2.8

8. Chronic obstructive pulmonary disease 17,698 1.9 Diabetes Mellitus 15,582 2.6

9. Tuberculosis 16,806 1.8 Colon and rectum cancers 11,763 2.0

10. Liver cancers 14,695 1.6 Leukeamia 8,915 1.5

Total (111 disease) 918,110 100 Total (111 disease) 594,797 100

Source: IPH, 2012

Table 6.2: Top 10 causes of burden of disease (DALYs), Malaysia, 2008

Rank DiseaseMales

DALYs %Disease

Female

DALYs %

1. Ischemic heart disease 186,429 11.5 Cerebrovascular diseases (Stroke) 95,361 7.8

2. Road traffic injuries 120,396 7.4 Diabetes Mellitus 93,782 7.7

3. Cerebrovascular diseases (stroke) 109,893 6.8 Ischemic heart disease 93,101 7.6

4. Diabetes Mellitus 94,001 5.8 Unipolar depressive disorders 69,723 5.7

5. Unipolar depressive disorders 48,358 3.0 Osteoarthritis 38,106 3.1

6. Alcohol use disorders 43,519 2.7 Breast cancer 34,141 2.8

7. Lower respiratory infections 43,404 2.7 Asthma 31,573 2.6

8. HIV 39,934 2.5 lower respiratory infections 30,606 2.5

9. Chronic obstructive pulmonary disease 39,749 2.4 Hearing loss 30,342 2.5

10. Hearing loss 31,587 1.9 Road traffic injuries 26,634 2.2

Total (111 disease) 1,623,814 100 Total (111 disease) 1,225,880 100

Source: IPH, 2012

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6.1.2. Modifiable Risk Factors

Unhealthy diets and other factors such as tobacco use, physical inactivity and the harmful use of alcohol havebeen identified as the preventable causes of NCD deaths (WHO, 2010).

Diet and nutrition are important factors for the promotion and maintenance of good health at all stages oflife. During the past two decades, surmounting evidence from population-based epidemiological studies hashelped to clarify the role of diet in preventing and controlling morbidity and premature mortality from NCDs.In nearly all countries of the world, accelerated industrialisation has resulted in rapid urbanisation, economicdevelopment and market globalisation, all of which have led to change in the standards of living. Theseglobal developments have led to major shifts in dietary patterns with consequent changes in dietary intake,characterised by high fat, high salt, refined carbohydrate and low-fibre levels.

The World Cancer Research Fund estimated that 27–39% of the main types of cancers can be prevented byimproving diet, physical activity and body composition (WCRF, 2014). Approximately 16 million (1.0%)DALYs and 1.7 million (2.8%) of deaths worldwide are attributable to low fruit and vegetable consumption.There is convincing evidence that excessive consumption of high-energy foods, such as processed foodsthat are high in fats and sugars, promotes obesity compared to low-energy foods such as fruits andvegetables. The amount of dietary salt consumed is an important determinant of blood pressure levels andoverall cardiovascular risk. Convincing evidence is available on the risk of coronary heart disease due tosaturated fat and trans-fat while replacement with monosaturated and polyunsaturated fat reduces the risk.There is also evidence that the risk of type 2 diabetes is directly associated with consumption of saturatedfat and trans-fat and inversely associated with consumption of polyunsaturated fat from vegetable sources.

While energy-dense, nutrient-poor diets increase the risk of NCDs, plant-based diets with plenty of fruit andvegetables have been found to be protective against NCDs particularly cardiovascular disease and somecancers.

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Figure 6.2: Purpose and scope of diet related non-communicable diseases(cancer, diabetes and cardiovascular disease)

6.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

Review the epidemiologyof NCDs

A

Consolidation ofavailable epidemiologyand aetiology data inrelation to diet-relatedNCD in Malaysia

A1

Case control/ cohortstudies on diet and

lifestyle risk factors inrelation to NCDs andmetabolic syndrome inmulti-ethnic population

groups

A2

Dietary patterns inassociation with NCDsand metabolic syndrome

A3

Social and environmentalfactors in association

with NCDs and metabolicsyndrome

A4

Conduct diet and lifestyleintervention studies

B

Intervention studies indifferent settings

(community, institution,work place, school)

B1

Impact of policies onNCDs

B2

Assess roles of functionalfoods in NCDs prevention

and management

B3

Develop new modalities:diagnosis & treatment

C

Developments offunctional foods/

nutraceuticals/ dietarysupplements for

addressing developmentof NCDs

C1

Identify nutritionalbiomarker of NCDs in

Malaysia

C2

Develop innovativetechniques for dietaryassessment training and

interventions

C3

Diet-Related Non-Communicable Diseases (NCDs)(Cancer, Diabetes and Cardiovascular Disease)

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6.3 Table of Nutrition Research Priority Area

The NRP Area is presented in two tables. Table 6.3 presents the relative ranks for suggested topics. Appendix6 presents the ranking criteria for the suggested topics in each research scope of this area.

Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

A. Review the A 1. Consolidation of Require more A 1.1 Systematic reviews and meta analysis on 2epidemiology of available epidemiology published data to the association of NCD with diet and lifestyleNCDs. and aetiology data in implement/ strengthen practices among Malaysians.

relation to diet-related future interventionNCDs in Malaysia. programmes for diet- A 1.2 Scoping review of studies on nutrition 1

related NCDs. promotion activities related to NCDs.

A 2. Case control/ Inadequate published A 2.1 Micronutrient status and risks of NCDs 3cohort studies on data on case controldiet and lifestyle risk and cohort studies in A 2.2 Consumption of fats and oils in relation 2factors in relation to view of dietary and to NCD risks.NCDs and metabolic lifestyle risk factorssyndrome in for NCD and metabolic A 2.3 Sugar and artificially sweetened 1multiethnic population syndrome among beverages intake and risks of NCDs.groups. Malaysians.

A 2.4 Glycemic control in relation to NCDs 4

A 3. Dietary patterns A 3.1 Night eating behaviours in relation to 4in association with NCD risk.NCDs and metabolicsyndrome. A 3.2 Consumption of meals away from home 5

in relation to NCD risks.

A 3.3 Plant based diets and its relationship to 1NCD risk.

A 3.4 Alcohol consumption (type, frequency 2and intensity) in selected Malaysian populationgroups.

A 3.5 Ultra processed foods and its contribution 3to NCD development.

A 4. Social and Inadequate published A 4.1 Determination of psychosocial factorsenvironmental factors data on social and influencing dietary behaviours leading to NCDs 2in association with environmental riskNCDs and metabolic factors for NCD and A 4.2 Dietary acculturation in association with 1syndrome. metabolic syndrome the development of NCDs.

among Malaysians.

B. Conduct diet and B 1. Intervention Inadequate data on B 1.1 Conduct theory grounded intervention 2lifestyle intervention studies in different effectiveness of studies on reduction of diet and lifestyle riskstudies. settings (community, current ongoing factors for NCDs (Cancer, diabetes, CVD, etc.).

institution, work place, interventionschool). programmes. B 1.2 The influence of social media on dietary 1

behaviour.

B 2. Impact of policies Inadequate data on B 2.1 Impact of removal of sugar subsidy on 1on NCDs. assessing impact of reduction of NCDs.

national policies onNCD emergence.

Table 6.3: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

B 3. Assess roles of Inadequate published B 3.1 RCTs on the efficacy and effectiveness of 1functional foods in RCTs to support role local functional foods, nutraceuticals andNCD prevention and of functional foods in dietary supplements for the prevention andmanagement. prevention and management of diet related NCDs.

management of NCDs.

C. Develop new C 1. Development of Inadequate developed C 1.1 Development and evaluation of potential 1modalities: diagnosis functional foods/ functional foods in local functional foods for prevention and& treatment. nutraceuticals/ relation to NCDs. treatment of NCDs.

dietary supplementsfor addressing C1.2 Development and evaluation of potential 3development of NCDs. dietary supplements for prevention and

treatment of NCDs.

C1.3 Development and evaluation of potential 2nutraceuticals for prevention and treatment ofNCDs.

C 2. Identify nutritional Inadequate scientific C 2.1 Studies on nutrigenomics and 1biomarkers of NCDs in data on the role and metabolomics in relation to NCDs.Malaysians. interaction between

diet/ nutrient intake,biomolecules andgenes in the Malaysianpopulation

Lack of published C 2.2 Identification of new nutritional 3scientific data on biomarkers for NCDs risk.nutritional biomarkersfor NCD in local C 2.3 Development of nutrigenomics-based 2population. personalized nutrition intervention

programmes.

C 3. Develop Indequate availability C 3.1 Development of novel/innovative valid 2innovative techniques and accessibility of tools for dietary assessment (eg:mobile apps).for dietary assessment innovative/ noveltraining and assessment for use in C 3.2 Development and evaluation of state-of- 3interventions. community, laboratory the-art educational tools for prevention of diet

and clinical settings. related NCDs (eg:social media).

C 3.3 Development and evaluation of 1personalized dietary interventions using web-based technology/mobile app technology.

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References

Bloom DE, Cafiero ET, Jane-Llopis E et al. (2011).The Global Economic Burden of Noncommunicable Diseases, Geneva.

Institute for Public Health (IPH) (2008). National Health and Morbidity Survey 2006 (NHMS III): Nutritional Status. Ministry ofHealth, Malaysia.

Institute for Public Health (IPH) (2012). National Institutes of Health, Ministry of Health, Malaysia (2012). The Second MalaysianBurden of Disease and Injury Study

Institute for Public Health (IPH) (2012). National Health and Morbidity Survey 2011: Non-communicable Diseases (Volume II).Ministry of Health, Malaysia.

Institute for Public Health (IPH) (2015). National Health and Morbidity Survey 2015:Non-Communicable Diseases, Risk Factors & Other Health Problems(Volume II). Ministry of Health, Malaysia.

Ministry of Health Malaysia: National Strategic Plan for Non-communicable Diseases (NSP-NCD) (2010-2014). Availablehttp://_www._moh._gov._my/_images/_gallery/_nspncd/_NSPNCD._pdf

Mozaffarian D. (2016). Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity. Circulation. 133 (2) : 187-225

WHO (2010). Global Status Report on Non-communicable Diseases 2010. World Health Organization, Geneva.

World Cancer Research Fund (2014). The link between food, nutrition, diet and non-communicable diseases. Availablewww.wcrf.org/sites/default/files/PPA_NCD_Alliance_Nutrition.pdf

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Area 7Food Composition

Database

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7.0 Food Composition Database

7.1 Introduction

The Nutrient Composition of Malaysian Foods Table was published in 1988 and it was revised and published in 1997(Tee et al., 1997). In this version, the table has 783 food items and 19 nutrients. Nutritionists, dietitians, foodscientists, food safety personnel, policy makers and the industry refer to food composition tables for variouspurposes. Recognizing the wide applications of food composition data, as outlined in Figure 7.1, there is an urgentneed to update the Malaysian Food Composition Database (MyFCD) with additional foods and nutrients.

Food labeling Nutrition intakes Diet formulation

ConsumerInformation

Food based dietryguidelines food aid/

fortification

Nutrition/ food security/health policies

Agriculturalpolicies

Nutrientrequirements

Research nutrient intake- disease

Breeding/ research

Food Composition Data

Figure 7.1: Uses of food composition data

Source: U.Ruth Charrondiere

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Furthermore, MyFCD should be updated in view of the increasing prevalence of diet-related chronic diseasesespecially diabetes, hypertension and hypercholestrolemia in Malaysia. This calls for updated data particulars of foodhigh in added salt, sugar and saturated fats. Such information maybe helpful for reformulation of the products aswell as to increase the effectiveness of nutritional interventions. The updated MyFCD will provide better quality ofnutrient data especially for health professionals, researchers in the field of food and nutrition, and those who areinvolved in food production and food preparation.

The International Network of Food Data Systems (INFOODS) was established by Food and Agriculture Organisationof The United Nations (FAO) in 1984, as a worldwide network to assist in the development of appropriate nationaldatabases to enhance the quality, availability, reliability, accessibility and use of food composition data. Regional food-composition databases have been established throughout the world with the goal of creating computerized systemsthat permit easy availability and interchange of food-composition data between regions and countries. As for thisregion, the Association of Southeast Asian Networks of Food Data Systems (ASEANFOODS) was formed in 1986under the auspices of INFOODS. Malaysia is a member of the ASEANFOODS, and actively participated in severalactivities organised by the ASEANFOODS and INFOODS.

The availability of an updated database will support various food and nutrition-related activities in providing dataon food composition. The updated MyFCD also serve as a reference for industry in developing and improving theirproducts. The roles of MyFCD in providing supports related problems are shown in Figure 7.2.

A conceptual framework of this NRP Area is given in Figure 7.3.

Figure 7.2: Food database towards preventing nutrition related problems

NRP1:Maternal, Infan and

Young Child Nutrition

NRP4:Macro and

Micronutrient Excesses andDeficiencies

NRP5:Overweight

andObesity

NRP6:Diet Related

Non-Comminicable Diseases

Industry

Food DatabaseTowards

PreventingNutrition -

Related Problems

NRP2:Monitoring and Evaluation Food

and Nutrition Security, Nutritional Status and

Programmes

NRP3:Life Course Food

Intake and DietaryPractices

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7.2 Conceptual Framework on the Purpose and Scope of the Research Priority Area

Food Composition Database (FCD)

Update data in thecurrent FCD

A

Update data on existingmacro and

micronutrients(e.g fatty acids, vitaminsand minerals) throughcollation of various

database anddevelopment of a quality

data collectionprocedures

A1

Expand the FCD

B

Add new food items

B1

Add new data onphytochemical and anti-

nutrients

C

Analysis on types andamounts of

phytochemical and anti-nutrients

C1

Improvement inmethodologies

D

Improve methods/methodologies (ie. Labanalysis, sampling,storage, and etc.)

D1

Establishment of reliable,accurate and validmethods of nutrient

analysis

D2

Figure 7.3 : Purpose and scope of food composition database

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7.3 Table of Nutrition Research Priority Area

The NRP Area is presented in two tables. Table 7.1 presents the relative ranks for suggested topics. Appendix 7presents the ranking criteria for the suggested topics in each research scope of this area.

Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

A. Update data in the A 1. Update data on 1. Scattered data A 1.1 Development of score quality procedure 1current FCD. existing macro and available. for data collation.

micronutrients (e.g. 2. No score qualityfatty acids, vitamins procedure for data A 1.2 Collation of existing data (published and 2and minerals) through collation. unpublished) into one database.collation of variousdatabase anddevelopment of aquality data collectionprocedure.

B. Expand the FCD B 1. Add new food Incomplete data of B 1.1 Include macronutrients (sugars, dietary 1items. macro and fibre, fatty acid compositions) in current FCD

micronutrients. especially in view of an increase prevalence ofNCDs e.g. CVD, DM, cancers.

B 1.2 Include micronutrients (e.g. iodine, folate, 2selenium, zinc, magnesium, iron, water and fatsoluble vitamins and amino acid compositions)in current FCD especially in view ofmicronutrient deficiencies.

B 2. Inclusion of Inadequate data on B 2.1 The effect of local food preparation and 6nutrient retention of nutrient retention due cooking methods on nutrient profilenew and underutilised to cooking of locally-foods. available foods.

Lack of data on B 2.2 Nutrient content of cooked, prepared and 3cooked foods and ethnic foods (including recipes and method ofethnic foods. preparation).

Inadequate data on B 2.3 Nutrient analysis on new foods (fusion 4new food and foods e.g. fried banana cheese fritters) andunderutilised food. underutilised foods (fruits,vegetables, tubers,

roots and animals).

Lack of data on B 2.4 Nutrient content of different cultivars of 5different cultivars of plant food (e.g. white rice, brown rice, red rice,plant food. highland rice, hybrid rice; fruits e.g. pisang

montel, vegetables e.g red spinach etc).

C. Add new data on C 1. Analysis on types Lack of data on C 1.1 Development of score quality procedure 1phytochemical and and amounts of phytochemical and for data collation on phytochemical (e.g.anti-nutrients. phytochemical and anti-nutrients of foods polyphenols, carotenoids, plant sterols and

anti-nutrients. in Malaysia. stanols etc.) in view of their recognisedimportance in prevention of NCDs.

C 1.2 Collation of existing data (published 3and unpublished) into one database.

C 1.3 Anti-nutrients contents (e.g. phytates, 2oxalates, trypsin inhibitors, caffein, tannin,theobromine etc) in plant foods.

Table 7.1: Relative ranks for suggested topics in each research scope

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Purpose Research Scope Research Gapsand Needs

Suggested Topic and/or Explanatory Notes

RelativeRank

D. Improvement in D 1. Improve Lack of robust, rapid D 1.1 Development/ adoption/ modification and 1methodologies. methods/ and methodologies validation of methodologies for analysis of

methodologies (i.e. using up-to-date all identified nutrients in FCD.Lab analysis, equipment.sampling, storage,and etc.).

D 2. Establishment of Poor coordination D 2.1 Proficiency Test (PT) programme for 1reliable, accurate and among laboratories quality control/ assurance of food data.valid methods of (universities, researchnutrient analysis. institutes and

government relatedlabs).

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References

INFOODS. 2016. The International Network of Food Data Systems(Available http://www.fao.org/infoods/infoods/).INFOODS Food Composition Challenges(Available http://www.fao.org/infoods/infoods/food-composition-challenges/en/)

Tee ES, Mohd Ismail N, Mohd Nasir A & Khatijah I (1997), Nutrient Composition of Malaysian Foods. 4th Edition. Malaysian FoodComposition Database Programme, Institute for Medical Research, Kuala Lumpur: 310p.

Greenfield H & Southgate DAT (2003), Food Composition Data – Production, Management and Use. 2nd Edition. Food andAgriculture Organization of the United Nations, Rome, Italy.

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Appendices

Ranking Criteria forSuggested Topics in Each

Research Scope

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Research Priority Area 1 : Maternal, Infant and Young Child NutritionAppendix 1 : Ranking criteria for suggested topics in each research scope

A. Assess relationship between A 1. Effects of maternal There is limited information By knowing the status ofmaternal nutritional status and anaemia on maternal, infant on the impact of anaemia on anaemia, appropriatehealth outcomes of mother, and young child health and chronic disease, psychological intervention can be taken toinfant and young child in later nutrition. and cognitive outcome. treat and prevent maternalstages of life. related diseases.

A 2. Effects of inappropriate There is limited information on By knowing the status ofgestational weight gain on the impact of inappropriate gestational weight gain,maternal, infant and young gestational weight gain on appropriate intervention canchild on health and nutrition. maternal chronic disease, be taken to treat and prevent

psychological and cognitive related consequences.outcome.

A 3. Effects of gestational There is limited information Gestational diabetes mellitusdiabetes mellitus on maternal, on the impact of gestational can have adverseinfant and young child health diabetes mellitus on maternal, consequences on maternaland nutrition. infant and young child health. and child health.

B. Determine nutritional status B 1. Impact of caregivers The availability of local studies Care feeding practicesof infants and young children. feeding practices on nutritional on this issue is limited. (controlling, restricting or

status of infant and young responsive) have been shownchild (IYC). to have an impact on nutritional

status of infant and youngchild.

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

Appendix 1

A 1.1 The impact of 10 10 6 7 33 1anaemia on maternalchronic disease,psychological andcognitive outcome.

A 1.2 The impact of 9 9 6 7 31 2anaemia on infant andyoung child growthand development

A 2.1 The impact of 10 10 6 6 32 1inappropriategestational weightgain on maternalhealth and nutrition.

A 2.2 The impact of 9 9 6 6 30 2gestational weightgain on infant andyoung child healthand nutrition.

A 3.1 The impact of 10 10 6 6 32 1gestational diabetesmellitus on maternalhealth and nutrition.

A 3.2 The impact of 9 9 6 6 30 2gestational diabetesmellitus on infant andyoung child healthand nutrition.

B 1.1 Determinants of 10 10 7 7 34 1infant and young childfeeding practices ofcaregivers.

B 1.2 Impact of care 9 10 7 7 33 2feeding practices onchild development(cognitive,psychomotor andpsycho-social).

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

B 2. Infant and young child The availablity of local studies Infant and young child feedingfeeding practices and health on these issues are limited. has a long term impact onoutcomes. growth, development and

health status.

Appendix 1

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

B 2.1 Relationship 10 10 7 7 34 1between infant andyoung child feedingpractices withmalnutrition(overweight, obesity,underweight, stuntingand wasting).

B 2.2 Relationship 6 7 6 6 25 5between infant andyoung child feedingwith diet-relatedchronic diseases inchildren, adolescentsand adults.

B 2.3 Relationship 7 7 6 6 26 4between infant andyoung child feedingpractices withinfections and allergies(acute respiratoryinfection, asthma,gastro enterities,eczema).

B 2.4 Relationship 8 9 6 6 29 3between infant andyoung child feedingwith micronutrientadequacy.

B 2.5 Relationship 6 6 6 6 24 6between infant andyoung child feedingwith macronutrientadequacy.

B 2.6 Impact of infant 9 9 6 7 31 2and young child feedingpractices on theirdevelopment (cognitive,psychomotor andpsycho-social).

Appendix 1

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

B 3. Dietary adequacy of infant Local studies on this area are Dietary adequacy is importantand young child. lacking. for better growth and

development.

B 4. IYC feeding practices of More information is needed for Socio-culture differencesmarginalised groups (single health and nutrition among the variousmothers, homeless, hardcore intervention strategies. marginalised groups (singleand urban poor). mothers, homeless, hardcore

and urban poor) affect feedingpractices, dietary intake andnutritional status. Informationis required to address theservice needs of themarginalised groups (singlemothers, homeless, hardcoreand urban poor).

B 5. Feeding practices among Lack of information on feeding Information is required toinfant and young child with practices among infant and address feeding practicesspecial needs (cerebral palsy young child with special needs among infant and young childand HIV). (eg. cerebral palsy and HIV) with special needs (cerebral

in Malaysia. palsy and HIV).

C. Strengthen implementation/ C 1. Evaluation of current Information on evaluation of Many programmes have beenservice delivery. strategies/ programmes/ infant and young child feeding implemented over the years.

policies. strategies/ programmes/ Hence, evaluation is neededactivities is limited. to assess the effectiveness of

the programmes.

Appendix 1

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

B 3.1 Dietary patterns 9 10 7 7 33 1** among infants andyoung child** Complementaryfeeding practices(timely, adequacy,types, frequency,safety) "

B 3.2 The use and 9 9 7 7 32 2impact of dietarysupplements (eg:vitamins, minerals)on infant and youngchild health andnutrition.

B 4.1 Dietary patterns 9 9 7 7 32 1and nutritional statusamong infant andyoung child ofmarginalised groups(single mothers,homeless, hardcoreand urban poor)

B 5.1 Dietary patterns 10 10 7 7 34 1and nutritional statusamong infant andyoung child with HIVand cerebral palsy.

C 1.1 Evaluate the 8 8 6 6 28 4effectiveness ofnutrition educationon IYC at health clinics.

C 1.2 Evaluate the 9 10 7 7 33 1effectiveness of postnatal home visit onbreastfeedingpractices.

C 1.3 Evaluate the 8 8 7 7 30 3effectiveness of motherfriendly care in BFHIsetting.

Appendix 1

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

D. Develop policies on infant D 1. Impact of advertisement, Lack of information on the Mother's choice of Growingfeeding code of protection. labelling and packaging. impact of promotion and Up Milk (GUM) and

advertisement on consumption complementary food may beof Growing Up Milk (GUM) influenced by aggressiveand complementary food. advertisement and promotion,

infomative labelling andattractive packaging of milkproducts.

D 2. Impact of mother-friendly Lack of information on the Providing mother-friendlysupport at workplace. effectiveness of the facilities at workplace may

implementation of mother support breastfeeding.friendly workplace strategiesby Suruhanjaya SyarikatMalaysia (SSM).

Appendix 1

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

C 1.4 Evaluate 8 9 5 5 27 5knowledge, attitudeand practice onbreastfeeding andcomplementaryfeeding amongcaregivers.

C 1.5 Evaluate the 9 9 7 6 31 2effectiveness oflactation training onhealth care providers.

C 1.6 Evaluate 8 8 5 5 26 6strategies to promotemilk consumptionamong pregnantwomen.

D 1.1 Impact of 9 10 7 6 32 1promotion andadvertisement ofmothers' choice oncomplementary foodand Growing Up Milk(GUM) (for examplesmother's and child'spreferences of milkbrand, price, availibilityand range of products).

D 1.2 Impact of the 9 10 6 5 30 2labelling and packagingof infant formula andrelated productstowards influencingparents choice fortheir infants andyoung child.

D 2.1 Impact of 10 10 6 7 33 1having lactation breaks,availability of crèche,breastfeeding room atworkplace and theduration of maternityleave on exclusivebreastfeeding andbreastfeeding duration.

Appendix 1

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

D 3. Strengthening the Information on evaluation of Several programmes havecurrent strategies/ maternal strategies/ been implemented over theprogrammes/ policies on programmes/ activities is years. Hence, evaluation ismaternal, infant and young limited in Malaysia. needed to improve thechild nutrition. effectiveness of the

programmes.

Appendix 1

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

D 2.2 Influence of 9 9 7 6 31 2paid leave of motherswho adopt infant on thesuccess of inducedlactation or relactation.

D 3.1 Evaluate the 9 9 6 6 30 3effectiveness of dietaryguidelines advice onanaemia, gestationaldiabetes mellitus andgestational weightgain.

D 3.2 Evaluate the 9 10 5 7 31 2effectiveness of fullcream milksupplementation inthe management ofgestational weightgain.

D 3.3 Evaluate the 10 10 7 7 34 1effectivenessmicronutrientsupplementationprogramme (folicacid, iron, vitamin Bcomplex andvitamin C)

Appendix 1

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

Research Priority Area 2 : Monitoring and Evaluation of National Food and Nutrition Security,Nutritional Status and Programmes

Appendix 2 : Ranking criteria for suggested topics in each research scope

A. Strengthen monitoring and A 1. Conduct regularly national Lacking data on trends. Ensuring proper planning,evaluation of national food surveys for monitoring global/ implementation, coordination,and nutrition security, national nutrition indicators. monitoring and evaluation ofnutritional status and programmes and projects.programmes.

A 2. Evaluate existingnational nutrition programmesof MOH/ other stakeholders.

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

A 1.1 National survey 9 9 7 7 32 1on the following scopeevery 5 years(Coordinated by theInstitute of PublicHealth).

• National Health &Morbidity Survey(NHMS); maternaland child health,2016.

• Malaysian School-based NutritionSurvey, 2017.

• NHMS; household,2019

• Malaysian NutritionSurvey (includingmajor componenton food security),2020.

• Nationalmicronutrientsurvey.

A 2.1 National 10 10 7 7 34 1evaluation of theRehabilitationProgramme forMalnourishedChildren. (2016).

A 2.2 National 8 8 7 7 30 3evaluation of SchoolMilk Programme onnutritional status ofchildren.

A 2.3 National 9 9 7 7 32 2evaluation of theimpact of the SchoolFeeding Programmeon nutritional statusof children.

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

A 3. Develop real time datacollection tools and analysisfor nutrition studies.

A 4. Enhance MyNutriApps for Existing Nutri apps onlymonitoring and evaluation of provides energypopulation dietary intake. recommendation based

on Malaysia DietaryGuidelines.

B. Monitoring national B 1. Carry out national Lack of national level data for The baseline data important fornutritional status and trends. nutritional surveys of suggested groups: needs assessment and decision

vulnerable groups (under making process (policies and5 children, women at • Food intake/ patterns programmes).reproductive age & • Anthropometryindigenous group) at • Biochemical statusregular interval. • Socio economic status

To fulfill the Global WorldHealth Assembly NutritonTarget by 2025.

B 2. Determine national food Currently no database on theand nutrition transition of the trend of food and nutritionMalaysian population over transition in Malaysia.time.

Appendix 2

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

A 2.4. National 7 7 7 7 28 4evaluation of theeffectiveness of theBaby Friendly HospitalInitiative.

A 3.1 Development of 10 10 7 7 34 1real time datacollection tools andanalysis for nutritionstudies.

A 3.2 Evaluation of 9 9 6 7 31 2acceptability, userfriendliness &practicality of real timedata collection toolsand analysis fornutrition studies.

A 4.1 Evaluation of 10 10 7 6 33 1acceptability, userfriendliness &practicality ofMyNutriApps

A 4.2 Assessment of 9 9 7 6 31 2population dietaryintake using databasefrom MyNutriApps

B 1.1 National nutrition 10 10 7 7 34 1surveys among under5 children.

B 1.2 National nutrition 9 9 6 6 30 2surveys among womenat reproductive age group.

B 1.3 National 8 8 6 7 29 3nutrition surveys ofindigenous population.

B 2.1 Meta-analysis on 7 6 5 18 1food and nutritiontransition of theMalaysian population.

Appendix 2

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Purpose Research Scope Research Gapsand Needs

Rationale forPriority Ranking

C. Determination of factors C 1. Determine factors No compherensive data for The baseline data importantinfluencing food and nutrition influencing food and nutrition factors on food and nutrition for need assessment andsecurity in the food system. security. security. decision making process

(policies and programmes).

C 2. Determine of Absence of national data.micronutrient intake andbiomarkers.

Lack of data on the bioavailabilityof micronutrients in local foodsand diets.

Appendix 2

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Suggested Topicand/ or

Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

B 2.2 Projection 6 5 5 16 2modeling on food andnutrition transition ofthe Malaysianpopulation

C 1.1 Effects of food 8 8 5 5 26 3price on food andnutrition security.

C 1.2 Effect of women 9 9 6 6 30 2empowerment onhousehold food andnutrition security.

C 1.3 Evaluation of the 10 10 7 7 34 1effects of governmentpolicies for foodproduction and tradeon nutrition securityof the population.

C 2.1 Determine 9 8 7 6 30 1dietary and bloodstatus ofmicronutrients(Vitamin A, vitamin D,vitamin B1, vitamin B2,vitamin B12, folate,iron, iodine, zinc,selenium, calcium,chromium, sodium,potassium) for all agegroups (national survey).

C 2.2 Determination of 8 8 7 6 29 2bioavailability ofmicronutrients in localfoods and diets.

Appendix 2

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Purpose Research Scope Research Gaps Suggested Research Topics

Research Priority Area 3 : Life Course Food Intake and Dietary PracticesAppendix 3 : Ranking criteria for suggested topics in each research scope

A. To understand the food A 1. Impact of nutrition on Lack of information on the A 1.1 To determineintake and dietary practices healthy growth and roles of diet and food contribution of optimalamong various age groups. development. components on normal growth nutrition to growth and

and development among cognitive development.Malaysian.

A 1.2 To identify markers(subjective and functional) forassessing healthy childdevelopment.

A 1.3 To assess dietary intakeof palm oil and palm oilproducts among Malaysianof all age groups.

A 2. Determination of 1) Lack of studies/ information A 2.1 Effects of social andenvironmental and societal on the relationship between economic changes as part offactors affecting foods and nutrition and Malaysian modernisation on food intakenutrition. environment. among Malaysians across the

life course.

2) To support human nutrition A 2.2 Differences in dietarypolicies that impact short and practices among variouslong term nutrition outcomes. cultures in Malaysia.

A 2.3 Socio-cultural factorsinfluencing intake of fast foodand convenient food amongvarious age groups.

A 2.4 Socio-cultural andenvironmental factorsinfluencing eating out and latenight eating practices.

A 2.5 To assess factorsinfluencing food choices andeating behaviour amongvarious age groups.

A 2.6 To examineenvironmental factors thataffect dietary practices.

A 2.7 To determine and socio-cultural determinants of foodhabits.

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

9 8 5 6 28 1

7 7 5 5 24 2

6 6 5 5 22 3

9 9 7 7 32 2

3 3 2 4 12 6

9 10 7 7 33 1

9 8 6 6 29 4

9 9 5 6 29 5

9 9 6 7 31 3

9 8 3 7 27 6

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Purpose Research Scope Research Gaps Suggested Research Topics

A 3. Determination of Lack of data between A 3.1 To identify gaps andnutrition- related behaviour behaviour and food choices barriers on practising healthyof various age groups. among Malaysians. eating.

A 3.2 To determine psycho-social factors influencing foodchoices among various agegroups.

A 3.3 To determine theinfluences of food marketingon food decision-makingamong children andadolescents.

A 4. Evaluation of variability in Limited information on A 4.1 To study nutrigeneticsresponses to diets and food metabolic responses to diets and nutrigenomics in relationintake. and food among Malaysians. to diet among ethnic groups,

especially in children andadolescents.

A 4.2 To determine metabolicresponses to diets and foodintake across the life course.

A 4.3 The role of geneticallymodified foods as part of ahealthy dietary intake.

A 4.4 To develop nutrigenomics-based personalised nutritionintervention programmes.

B. Effective strategies/ B 1. Identification of effective B 1.1 To identify trainingprogrammes to promote interventions to promote needs to protect childrenhealthy dietary practices of healthy dietary practices against inappropriatevarious age groups. among various age groups. marketing on unhealthy food.

B 1.2 To evaluate the impact ofthe intergration of nutritioncomponents into ''KebunDapur Project'' in improvingdietary awareness amongpreschool and school children.

B 1.3 To evaluate the feasabilityof providing healthy schoolmeals to improve dietarypractices among schoolchildren.

Appendix 3

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

9 9 5 7 30 2

7 7 6 6 26 3

8 9 7 7 31 1

7 6 7 3 23 2

6 6 6 3 21 4

8 8 7 4 27 1

7 5 7 3 22 3

10 10 7 7 34 1

7 7 5 5 24 10

9 9 5 5 28 6

Appendix 3

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B 1.4 To evaluate the impact ofthe “School Meal Programme”in selected schools to improvedietary practices among schoolchildren.

B 1.5 Meta-analysis of theeffectiveness of hard policiesapproach in transformingdietary practices of thepopulation.

B 1.6 To evaluate the impactof providing healthy foodchoices at work place, schools,colleges, institutions on dietarypractices.

B 1.7 To identify theeffectiveness of communityempowerment strategies inpromoting healthy eatingamong various age groups.

B 1.8 To identify effectivestrategies to reduce salt intakeamong Malaysians.

B 1.9 To determine factorsaffecting fruits and vegetableintakes among Malaysian ofvarious age groups.

B 1.10 To identify effectivestrategies to reduce sugarintake among Malaysians.

B 1.11 To evaluate theeffectiveness and acceptanceof web-based nutritioneducation.

B 1.12 To identify innovativestrategies in promoting healthyeating among various agegroups.

B 1.13 To evaluate theeffectiveness of food-basededucational tools to promotehealthy eating amongMalaysians.

Purpose Research Scope Research Gaps Suggested Research Topics

Appendix 3

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7 7 6 6 26 9

9 10 6 6 31 3

9 9 7 7 32 6

8 10 6 6 30 4

10 8 6 5 29 5

8 8 6 6 28 6

10 7 6 5 28 6

10 10 5 6 31 3

7 8 5 6 26 9

9 9 6 6 30 4

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

Appendix 3

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Purpose Research Scope Research Gaps Suggested Research Topics

B 1.14 To identify theeffectiveness of social mediain promoting nutrition tovarious age groups.

B 1.15 To develop nutrientprofiling models for Malaysianfoods.

B 1.16 To identify effectivestrategies to promote milkconsumption among children.

B 1.17 To conduct cost-effective analysis on selectednutrition programmes.

C. To understand the C 1. Determination on the Limited information/ studies C 1.1 Sugar-sweetenedconsequences of unhealthy consequences of unhealthy on the consequences of beverages consumption amongdietary practices on health dietary practices of unhealthy dietary practices on Malaysians.status in later stages of life. various agegroups. health status in later life.

C 1.2 Salt intake amongMalaysians.

C 1.3 Milk consumptionamong various age groups.

C 1.4 Effects of marketing ofunhealthy foods on dietarypractices among children andadolescents.

C.1.5 Factors affecting fruitand vegetable intakes amongMalaysian of various age groups.

C 1.6 To determine dietarypatterns and effects on healthoutcome.

C 2. Identification of under and Limited information/ studies C 2.1. Determine associationover nutrition and the effect on on the consequences of between macro-andhealth status in later stages unhealthy dietary practices micronutrient intake and healthof life. on health status in later life. outcomes in later stages of life.

C 2.2. Effects of earlychildhood over-nutrition onmorbidity and mortality.

C 2.3 To investigate lifestyles,dietary habits and risk factorsamong children, adolescentsand adults.

Appendix 3

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

8 9 6 6 29 5

7 7 6 6 26 9

8 7 6 6 27 8

9 9 7 6 31 3

9 9 4 6 28 4

10 10 7 5 32 2

8 7 4 6 25 5

9 9 7 7 32 2

10 10 7 7 34 1

9 8 6 6 29 3

9 10 4 4 27 3

8 10 5 6 29 2

9 9 7 6 31 1

Appendix 3

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Purpose Research Scope Nutrients Research Gaps and Needs

Research Priority Area 4 : Macro and Micronutrient Excesses and DeficienciesAppendix 4 : Ranking criteria for suggested topics in each research purpose

A. Strengthen epidemiological A 1. Assessment of association Assess micronutrients status Lack of data for policy andand clinical understanding. between macro and of various age groups in terms programmes.

micronutrient status with of dietary intake and blood/health outcomes. urine concentration:

vitamin A, vitamin D,vitamin B1, vitamin B2,vitamin B12, folate, iron,iodine, zinc, selenium,calcium, chromium, sodium,potassium.

B. Develop and evaluate B 1. Evaluation of current Lack of data at national level.appropriate studies and intervention strategies onintervention strategies. macronutrient intake and

status.

B 2. Evaluation of current Folic acid, iron, vitamin C, Lacking data on haematinicintervention strategies on vitamin B complex supplementation in pregnancy:micronutrient intake and (haematinics).status. 1. Compliance by mothers

2. Cost effectiveness ofsupplementation programme.

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Suggested Topic and/or Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

A 1.1 Determine 8 8 5 5 26 2association betweenmicronutrient intakeand health outcomes(obesity, diabetes,hypertension,stunting).

A 1.2 To asesss impact 10 10 6 6 32 1of micronutrient statuson growth andcognitive developmentof children.

B 1.1 To identify 8 9 5 5 27 1effective strategies forthe prevention andcontrol ofmacronutrientdeficiency in all agegroup.

B 2.1 Scale up nutrition 8 8 6 7 29 1intervention towardsweekly haematinicsupplementationamong pregnantwomen and femaleadolescent.

B 2.2 Undertake cost 8 8 6 6 28 2effectiveness studyof haematinicsupplementationamong pregnantwomen.

B 2.3 Relationship between 8 8 6 4 26 3LBW with maternalmicronutrient status.

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Purpose Research Scope Nutrients Research Gaps and Needs

Iodine Increasing findings ofcongenital hypothyroidism ininfants in Peninsular Malaysia.Lacking data on maternaliodine status.

B 3. Development of novel Sodium and potassium. Lack of national data onstudies and strategies to sodium and potassium intakeimprove macro and and health risk.micronutrient statusof all age groups.

Iron, folate Lacking data on iron and folatestatus (intake and blood) offemale adolescents.

Need data for effectiveness ofwheat flour fortification.

Appendix 4

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Suggested Topic and/or Explanatory Notes

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Statusand/or

Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality,Cost and Time

Importance orClient

Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2Criteria *

TotalScore

RelativeRank

B 2.4 Determine 8 8 5 4 25 4effectiveness ofUniversal SaltIodisation (USI)among pregnantmothers betweengazetted and nongazetted areas.

B 3.1 Conduct 6 6 5 5 22 7interventions towardreducing sodium andincreasing potassiumintake.

B 3.2 Conduct 6 6 6 5 23 6intervention studiesof iron and folic acidsupplementation onfemale adolescent

B 3.3 Determine pre 7 7 5 5 24 5and post fortificationof iron and folatestatus.

Appendix 4

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

A. Improve understanding on A 1. Determination of BMI and Waist circumference is an A 1.1 Definition of BMI cut-offsthe epidemiology of obesity. WC cut-offs for Malaysians. important indicator of central for Malaysians based on body

obesity. Cuts-offs for waist fat compositions.circumference of adults areknown, but not for children A 1.2 Cohort study to identifyand adolescents. appropriate of BMI cut-offs for

Malaysians based on co-morbidities.

A 1.3 Identify appropriate ofWC cut-offs for Malaysianadults based on co-morbidities.

A 2. Relationship between There is lack of sufficient data A 2.1 Relationship betweenadiposity and cardiovascular and the consequence of higher body composition andrisk factor. body fat in Malaysian has not morbidity in adult Malaysians.

been scientifically established.A 2.2 Relationship betweenbody composition and healthrisks in children andadolescents.

A 3. Impact of early nutrition Defining early predictors of A 3.1 To establish appropriateon development of adult obesity in Malaysia is growth standard chart fromobesity. important, as premature age birth to adulthood in order to

of adiposity rebound and define the normal age-rangecatch-up growth (after foetal, for onset of adiposity reboundneonatal and infant growth of healthy children in variousretardation) have repeatedly ethnic groups in Malaysiabeen shown to be strong (cohort study).determinants of later obesity.

A 3.2 To define whichpediatric population groupsare at risk to show neonatalor post-natal catch-up growth.

A 3.3 The relationship betweengestational weight gain andbreastfeeding practices on thedevelopment of obesity.

A 4. Impact of obesity to Economic cost of obesity in A 4.1 The economic andeconomic and social cost in Malaysia need to be assessed personal health costs ofMalaysia. as increased cost of obesity- overweight and obesity.

related healthcare that Malaysiacan ill-afford. A 4.2 The economic burden of

obesity and obesity-relatedchronic diseases.

Research Priority Area 5 : Overweight and ObesityAppendix 5 : Ranking criteria for suggested topics in each research scope

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

8 7 4 3 22 3

8 7 5 4 24 2

8 8 6 7 29 1

7 8 7 4 26 1

7 8 5 4 24 2

8 8 6 4 26 2

8 8 4 6 26 2

8 8 6 5 27 1

8 6 6 7 27 1

8 6 6 7 27 1

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

Obesity has a significant A 4.3 Psycho-socio-culturalimpact on health-related quality determinants of quality of lifeof life and functional capacity in obese population.of individual in the society.

A 4.4 Psychosocial problemsrelated to obesity amongchildren in schools.

A 4.5 Childhood obesity,educational trajectories andschool failure.

A 5. Association of dietary Appetite control studies have A 5.1 Effects of fatty acids onintake, appetite control and never been reported in appetite control.eating behaviour with obesity Malaysia. There is a need toin Malaysia. understand the effect of palm- A 5.2 Effects of proteins and

based oil and fats, as well as amino acids on appetite control.protein, on appetite control.

A 5.3 Investigation on appetitebiomarkers among obesechildren.

Eating behaviour especially A 5.4 Night eating behaviourhigher consumption during and syndrome and itsnight-time and dieting may relationship with obesity.affect energy intake.Psychological mechanisms A 5.5 Energy intake regulationinfluencing eating may help among shift worker.maintain appropriate bodyweight gain. Improper weight A 5.6 Identification ofloss methods may lead to yoyo psychological mechanismseffect on body weight. influencing eating behaviour.

A 5.7 Relationship betweenstress and eating behaviour.

A 5.8 Weight loss methodsbeing practised by Malaysianpopulation.

A 5.9 Dieting behaviour andbody weight of adolescentsand young adults.

A 5.10 The role of dietcomposition on body weight -(relevant food database: sugar,fatty acids, prepared meals/cooked foods, fast foods,international cuisine).

Appendix 5

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

7 7 6 6 26 2

7 8 6 6 27 1

6 6 5 5 22 3

7 6 5 3 21 7

7 6 5 3 21 7

7 6 5 3 21 7

9 9 7 6 31 1

7 7 7 6 27 5

8 8 7 6 29 3

8 8 7 6 29 3

8 8 6 6 28 4

8 7 6 5 26 6

9 9 6 6 30 2

Appendix 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

A 6. Determination of socio- Public perception of health in A 6.1 Parental perception ofcultural factors influencing relation to obesity influences childhood obesity.obesity. the success of obesity

prevention and management. A 6.2 Food cultures andsocio-cultural determinants offoodhabits (including nativeminorities).

A 6.3 Socio-culturaldeterminants of body image.

A 6.4 Inter-disciplinaryapproach to decision makingin food and nutrition (nutritionsociology, anthropology andpsychology).

A 6.5 Obesity at workplace,stigmatization, well being andproductivity.

A 6.6 Understanding babiesborn SGA and its effects onobesity, metabolic syndrome,hypertention, insulin resistanceand diabetes.

A 7. Effect of metabolic Identification of individuals A.7.1 Metabolic predispositionpredisposition to onset of who are prone to obesity is to adult-onset of obesity.obesity. important as there is poor

prognosis for the success of A 7.2 Metabolic predispositionlong-term management of to childhood-onset of obesity.obesity.

A 8. Association between With the advent of A 8.1 Effect of working hourssedentary lifestyle and obesity. technological advances, on opportunity for physical

Malaysians lead a sedentary activity and exercise.lifestyle and consequentlyhigher rates of obesity. There is A 8.2 Survey of existinga need for in depth physical activity curriculumunderstanding of the current and co-curriculum programmesituation and factors affecting in schools.physical inactivity.

A 8.3 Assessment of physicalactivity level in relation toobesity (including objectivemethods).

A 8.4 Factors influencingphysical activity level in adultsand older adults.

Appendix 5

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

7 7 6 6 26 3

8 9 6 6 29 1

8 8 5 5 26 3

8 8 6 6 28 2

7 8 6 5 26 3

8 8 7 6 29 1

7 8 6 6 27 1

7 8 6 6 27 1

8 8 6 6 28 4

7 7 5 6 25 6

8 8 5 6 27 5

9 9 6 6 30 3

Appendix 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

A 8.5 Factors influencingphysical activity level ofchildren and adolescents.

A 8.6 Sedentary behaviour andobesity.

A 8.7 Physical activity,sedentary behaviour andphysical fitness in overweightand obese.

A 8.8 Using GeographicInformation Systems (GIS)to show trends in obesity(including fitness center,recreational center and 24hours food outlet).

A 8.9 Relationship betweensleeping pattern and obesity inall age groups.

A 9. Determination of genetic Genes and the environment A 9.1 The genetics of childhoodfactors influencing interact to influence obesity.development of overweight development of overweightand obesity. and obesity. To date, there is A 9.2 Determination of

no known study in this area heritability of obesity-relatedcarried out in Malaysia. phenotypes.

A 9.3 Phenotyping of eatingbehaviour and food intake.

B. Improve effectiveness of B 1. Development and In dealing with inequalities in B 1.1 Development andintervention and management evaluation of obesity health status as a fundamental evaluation of school-basedof obesity. prevention and intervention. principle of public health, it is behavioural intervention

necessary to consider the programmes for the preventionspecific issues which make of overweight in children.particular groups morevulnerable to weight gain. B 1.2 Development,There is a lack of available implementation andmodel for the prevention and assessment of the effectivenessintervention of obesity. of appropriate obesity

intervention programmes inschools.

Appendix 5

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

9 9 6 6 30 3

9 9 7 6 31 2

9 9 6 6 30 3

9 9 7 7 32 1

8 8 6 6 28 4

7 7 6 7 27 2

7 7 6 7 27 2

9 9 5 6 29 1

9 9 5 5 28 3

9 9 5 5 28 3

Appendix 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

B 1.3 Effectiveness of existingnutrition and physical activitycurriculum and co-curriculumprogramme in schools.

B 1.4 Evaluation of bestpractices in workplace andinstitutional for obesityprevention and treatment.

B 1.5 Effectiveness of existingobesity interventionprogrammes to reduceprevalence of diabetes,hypertention and cardiovasculardisease in community (i.e.:KOSPEN iniatitive. Jom Mama& MyBFF).

B 1.6 Effectiveness of park-based obesity prevention andmanagement programme.

B 1.7 Evaluation on theeffectiveness of the mediacampaign to prevent obesity.

B 1.8 Impact of televisionadvertising of foods/beverageshigh in fat and/or high in sugarin childhood obesity.

B 1.9 Cost effectiveness ofobesity prevention and/orintervention programmes.

B 2. Development and Success rate of the various B 2.1 Effectiveness of drugsevaluation of obesity approaches to obesity and supplements/herbs inmanagement. management is low, and as obesity management.

such there is a need to developmore practical and effective B 2.2 Development andapproaches. evaluation of behavior

modification strategies formanagement of obese adults/children.

B.2.3 Development andevaluation of strategies forpromotion of weight loss andweight maintenance, andprevention of weight regain.

Appendix 5

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

7 7 5 6 25 5

8 8 6 6 28 3

10 9 7 7 33 1

7 7 6 4 24 6

7 7 6 5 25 5

7 7 7 6 27 4

10 9 7 6 32 2

8 5 5 5 23 2

8 8 6 6 28 1

8 8 6 6 28 1

Appendix 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

B 2.4 Effectiveness of healtheducation in managing obesityand its co-morbidities.

B.3 Impact of policies and There is lack of data on the B 3.1 Determination of politicalenvironment on obesity. impact of policies and the and macro sociological factors

environment on obesity. To that contribute to overweightprevent and manage obesity, and obesity in the population.governments, food industries,the media, communities and B 3.2 Evaluation of theindividuals need to work feasibility of providingtogether to modify the incentives to employees thatenvironment so that it is less support health eating habitsconducive to weight gain. and active lifestyle.

B 3.3 The role of food industryadvertising and broadcastingagencies towards healthyeating and obesity prevention.

B 3.4 The role of restaurantsand food service industriestowards healthy eating andobesity prevention.

B 3.5 Effectiveness of foodservice and restaurantempowerment programme onobesity prevention andmanagement.

B 3.6 The impact of builtenvironment on physicalactivity and obesity prevention.

B 3.7 The ‘obesogenic’environment and its effects ondietary intake and obesity.

B 3.8 Compliance of foodservice providers towardsexisting guidelines.

B 3.9 Socio-culturaldeterminants of the receptionof public health and nutritionmessages by subpopulation inorder to develop target policies.

Appendix 5

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

6 6 5 6 23 2

9 9 7 6 31 1

8 8 5 6 27 5

9 9 6 5 29 3

9 9 6 5 29 3

8 8 6 6 28 4

9 9 5 6 29 3

9 9 5 6 29 3

8 8 5 6 27 5

8 8 6 5 27 5

Appendix 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

B 3.10 Agriculture subsidies onfood production and supply aswell as cost and consumptionpattern on development ofobesity.

B 3.11 Identification ofenvironmental factors that canbe changed to improve physicalactivity levels.

B 3.12 Association between useof Sugar Sweetened Beverages(SSB) and childhood obesityprevalence.

B 3.13 Effects of sugarsubsidies removal with obesityprevalence.

C. Developing new modalities C 1. Identification of method to Obesity has traditionally been C 1.1 Identifications of otherdefine obesity. defined based on BMI cut-offs. indices to define obesity.

However, it is known that BMIdoes not truly reflect bodycomposition.

C 2. Identification of novel Functional foods and herbal C 2.1 Identification of foodsstrategies to prevent obesity. traditional medication have rich in specific ingredients

been used for the prevention (e.g. specific fatty acids, otherand treatment of obesity. phytochemicals) that canHowever, there has been no stimulate thermogenesis andscientific evidence on the fat oxidation polyphenolsefficacy and safety. (assessed by indirect

calorimetry) as well as improveglucose tolerance (assessedby OGTT).

C 2.2 Identification of localbioactive food ingredients.

Novel and practical intervention C 2.3 Comparison on thestrategies are important for the effectiveness of differenttreatment of obesity. methods of weight reduction

for obese individuals.

C 2.4 Randomized ControlTrials of obesity preventionprogrammes (individual/ group).

C 2.5 Psyco sociological andnutritional management andassessment of bariatric surgeryfor obese subjects.

Appendix 5

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

7 7 5 4 23 6

9 9 6 6 30 2

7 8 7 6 28 4

8 9 6 6 29 3

6 6 6 5 23 1

7 5 5 5 22 2

7 7 5 6 25 4

8 8 6 5 27 3

9 8 6 6 29 1

9 7 6 6 28 2

Appendix 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

A. Review the epidemiology of A 1. Consolidation of available Require more published data A 1.1 Systematic reviews andNCDs. epidemiology and aetiology to implement/ strengthen meta analysis on the association

data in relation to diet-related future intervention programmes of NCDs with diet and lifestyleNCD in Malaysia. for diet-related NCDs. practices among Malaysians.

A 1.2 Scoping review ofstudies on nutrition promotionactivities related to NCDs.

A 2. Case control/ cohort Inadequate published data on A 2.1 Micronutrient status andstudies on diet and lifestyle risk case control and cohort studies risks of NCDs.factors in relation to NCDs and in view of dietary and lifestylemetabolic syndrome in risk factors for NCD and A 2.2 MConsumption of fats andmultiethnic population groups. metabolic syndrome among oils in relation to NCD risks.

Malaysians.A 2.3 Sugar and artificiallysweetened beverages intake andrisks of NCDs.

A 2.4 Glycemic control inrelation to NCDs.

A 3.. Dietary patterns in A 3.1 Night eating behaviours inassociation with NCDs and relation to NCD risk.metabolic syndrome.

A 3.2 Consumption of mealsaway from home in relation toNCD risks.

A 3.3 Plant based diets and itsrelationship to NCD risk.

A 3.4 Alcohol consumption(type, frequency and intensity)in selected Malaysian populationgroups.

A 3.5 Ultra processed foodsand its contribution to NCDdevelopment.

A.4 Social and environmental Inadequate published data on A 4.1 Determination offactors in association with social and environmental risk psychosocial factorsNCDs and metabolic syndrome. factors for NCD and metabolic influencing dietary behaviours

syndrome among Malaysians. leading to NCDs.

A 4.2 Dietary acculturation inassociation with thedevelopment of NCDs.

Research Priority Area 6 : Diet-Related Non-Communicable Diseases (Cancer, Diabetes and Cardiovascular Disease)Appendix 6 : Ranking criteria for suggested topics in each research scope

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

7 7 7 5 26 2

7 7 7 6 27 1

7 8 6 7 28 3

7 8 7 7 29 2

8 8 7 7 30 1

6 8 7 6 27 4

8 8 6 6 28 4

8 7 7 6 27 5

9 8 7 7 31 1

8 8 7 7 30 2

8 8 6 7 29 3

8 8 6 7 29 2

8 8 7 7 30 1

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

B. Conduct diet and lifestyle B 1. Intervention studies in Inadequate data on B 1.1 Conduct theory groundedintervention studies. different settings (community, effectiveness of current intervention studies on

institution, work place, school). ongoing intervention reduction of diet and lifestyleprogrammes. risk factors for NCDs (Cancer,

diabetes, CVD, etc.).

B 1.2 The influence of socialmedia on dietary behaviour.

B 2. Impact of policies on Inadequate data on assessing B 2.1 Impact of removal ofNCDs. impact of national policies on sugar subsidy on reduction

NCD emergence. of NCDs.

B.3 Assess roles of functional Inadequate pubished RCTs to B 3.1 RCTs on the efficacy andfoods in NCD prevention and support role of functional foods effectiveness of local functionalmanagement. in prevention and management foods, nutraceuticals and

of NCDs. dietary supplements for theprevention and managementof diet related NCDs

C. Develop new modalities: C 1. Development of functional Inadequate developed C 1.1 Development anddiagnosis & treatment. foods/ nutraceuticals/ dietary functional foods in relation to evaluation of potential local

supplements for addressing NCDs. functional foods for preventiondevelopment of NCDs. and treatment of NCDs.

C 1.2 Development andevaluation of potential dietarysupplements for preventionand treatment of NCDs.

C 1.3 Development andevaluation of potentialnutraceuticals for preventionand treatment of NCDs.

C 2. Identify nutritional Inadequate scientific data on C 2.1 Studies on nutrigenomicsbiomarkers of NCDs in the role and interaction and metabolomics in relationMalaysians. between diet/ nutrient intake, to NCDs.

biomolecules and genes in theMalaysian population.

Lack of published scientific C 2.2 Identification of newdata on nutritional biomarkers nutritional biomarkers forfor NCD in local population. NCDs risk.

C 2.3 Development ofnutrigenomics-basedpersonalized nutritionintervention programmes.

Appendix 6

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107

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

8 7 7 7 29 2

8 8 7 7 30 1

8 8 7 7 30 1

8 8 7 7 30 1

8 8 7 7 30 1

7 7 6 6 26 3

8 8 7 6 29 2

9 8 7 5 31 1

8 8 7 6 29 3

8 8 7 7 30 2

Appendix 6

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108

Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

C 3. Develop innovative Indequate availability and C 3.1 Development of novel/techniques for dietary accessibility of innovative/ innovative valid tools for dietaryassessment training and novel assessment for use in assessment (eg:mobile apps)interventions. community, laboratory and

clinical settings. C 3.2 Development andevaluation of state-of-the-arteducational tools forprevention of diet related NCDs(eg:social media).

C 3.3 Development andevaluation of personalizeddietary interventions usingweb-based technology/mobile app technology.

Appendix 6

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109

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

7 7 7 7 28 2

7 7 6 7 27 3

8 8 7 7 30 1

Appendix 6

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110

Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

A. Update data in the current A 1. Update data on existing 1. Scattered data available. A 1.1 Development of scoreFCD. macro and micronutrients 2. No score quality procedure quality procedure for data

(e.g. fatty acids, vitamins and for data collation. collation.minerals) through collationof various database and A 1.2 Collation of existing datadevelopment of quality data (published and unpublished)collection procedure. into one database.

B. Expand the FCD B.1 Add new food items. Incomplete data of macro and B 1.1 Include macronutrientsmicronutrients. (sugars, dietary fibre, fatty

acid compositions) in currentFCD especially in view of anincrease prevalence of NCDse.g. CVD, DM, cancers.

B 1.2 Include micronutrients(e.g. iodine, folate, selenium,zinc, magnesium, iron, waterand fat soluble vitamins andamino acid compositions) incurrent FCD especially in viewof micronutrient deficiencies.

B 2. Inclusion of nutrient Inadequate data on nutrient B 2.1 The effect of local foodretention of new and retention due to cooking of preparation and cookingunderutilised foods. locally-available foods. methods on nutrient profile.

Lack of data on cooked, foods B 2.2 Nutrient content ofand ethnic foods. cooked, prepared and ethnic

foods (including recipes andmethod of preparation).

Inadequate data on new food B 2.3 Nutrient analysis onand underutilised food. new foods (fusion foods e.g.

fried banana cheese fritters)and underutilised foods (fruits,vegetables, tubers, roots andanimals).

Lack of data on different B 2.4 Nutrient content ofcultivars of plant food. different cultivars of plant

food (e.g. white rice, brownrice, red rice, highland rice,hybrid rice; fruits e.g. pisangmontel, vegetables e.g. redspinach etc.).

Research Priority Area 7 : Food Composition DatabaseAppendix 7 : Ranking criteria for suggested topics in each research scope

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111

Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

10 10 7 7 34 1

9 9 6 6 30 2

10 10 7 7 34 1

9 10 7 7 33 2

7 6 5 5 23 6

8 9 7 7 31 3

8 8 7 6 29 4

5 7 6 6 24 5

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Purpose Research Scope Research Gaps and Needs Suggested Topic and/ orExplanatory Notes

C. Add new data on C 1. Analysis on types and Lack of data on phytochemical C 1.1 Development of scorephytochemical and anti- amounts of phytochemical and anti-nutrients of foods in quality procedure for datanutrients. and anti-nutrients. Malaysia. collation on phytochemical.

(e.g. polyphenols, carotenoids,plant sterols and stanols etc.)in view of their recognisedimportance in prevention ofNCDs

C 1.2 Collation of existing data(published and unpublished)into one database.

C 1.3 Anti-nutrients contents(e.g. phytates, oxalates, trypsininhibitors, caffein, tannin,theobromine etc.) in plantfoods.

D. Improvement in D 1. Improve methods/ Lack of robust, rapid and D 1.1 Development/ adoption/methodologies. methodologies (i.e. Lab methodologies using up-to- modification and validation of

analysis, sampling, storage, date equiptment. methodologies for analysis ofand etc.) all identified nutrients in FCD.

D 2. Establishment of reliable, Poor coordination among D 2.1 Proficiency Test (PT)accurate and valid methods of laboratories (universities, programme for quality control/nutrient analysis. research institutes and assurance of food data.

government related labs).

Appendix 7

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Ranking Criteria(Score 1-10)*

Big Impact OnHealth Status

and/or Delivery ofServices

Great PublicHealth

Significance

CapacityStrengthening

Gap InKnowledge/Evidence thatNecessitatesResearch

Feasibility,Practicality, Costand Time

Importance orClient Satisfaction

Ranking Criteria (Score 1-7) - Choose Max. 2 Criteria*

Total Score RelativeRank

8 10 7 7 32 1

6 6 7 3 22 3

8 9 7 7 31 2

10 10 7 7 34 1

9 8 7 6 30 1

Appendix 7

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Abbreviations

AAP : American Academy of Paediatrics

BMI : Body mass index

CVD : Cardiovascular disease

DALYs : Disability Adjusted Life Years

DM : Diabetes Mellitus

FAO : Food and Agriculture Organisation of The United Nations

FCD : Food composition database

GIS : Geographic Information Systems

IPH : Institute of Public Health

IYCF : Infant and Young Child Feeding Practices

LBW : Low Birth Weight

MP : Malaysia Plan

MSNS : Malaysia School-Based Nutrition Survey

MANS : Malaysian Adult Nutrition Survey

NCCFN : National Coordinating Committee on Food and Nutrition

NCD : Non-communicable disease

NGOs : Non-governmental organisations

NHMS I : First National Health and Morbidity Survey

NHMS II : Second National Health and Morbidity Survey

NHMS III : Third National Health and Morbidity Survey

NPANM : National Plan of Action for Nutrition of Malaysia

NRP : Nutrition Research Priorities

SDG : Sustainable Development Goals

SIDS : Sudden Infant Death Syndrome

UNICEF : United Nations Children's Fund

USI : Universal Salt Iodisation

WC : Waist circumference

WHO : World Health Organization

Page 145: research priorities in malaysia research priorities in malaysia

NUTRITION DIVISIONMinistry of Health, MalaysiaLevel 1, Block E3, Complex EFederal Government Administration Centre62590 Putrajaya, MALAYSIA

http://nutrition.moh.gov.my

ISBN 978-967-0769-62-2

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