Prevalence of undernutrition and associated factors in young children in Malaysia: A nationwide survey

Way Seah Lee; Muhammad Yazid Jalaludin; Kim Mun Khoh; Juan Loong Kok; Thiyagar Nadarajaw; Anna Padmavathy Soosai; Firdaus Mukhtar; Yong Junina Fadzil; Azriyanti Anuar Zaini; Siti Hawa Mohd-Taib; Rozanna M Rosly; An Jo Khoo; Hon Kit Cheang

doi:10.3389/fped.2022.913850

Prevalence of undernutrition and associated factors in young children in Malaysia: A nationwide survey

Front Pediatr. 2022 Aug 18:10:913850. doi: 10.3389/fped.2022.913850. eCollection 2022.

Authors

Affiliations

¹ Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
² Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang, Malaysia.
³ Paediatric Unit, Gleneagles Medical Centre, Kota Kinabalu, Sabah, Malaysia.
⁴ Paediatric Unit, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
⁵ Paediatric Unit, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
⁶ Prince Court Medical Centre, Kuala Lumpur, Malaysia.
⁷ Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
⁸ Klinik Pakar Kanak-Kanak Junina, Petaling Jaya, Selangor, Malaysia.
⁹ Department of Dietetics, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
¹⁰ Dietetic Services Department, UM Specialist Centre, Kuala Lumpur, Malaysia.
¹¹ Department of Dietetics and Food Service, Lam Wah Ee Hospital, Georgetown, Penang, Malaysia.
¹² Paediatric Unit, Lam Wah Ee Hospital, Georgetown, Penang, Malaysia.

Abstract

Introduction: Undernutrition in young children is a significant public health problem globally. We determined the prevalence of and factors predisposing to stunting and underweight in children aged 1 to 5 years in Malaysia.

Materials and methods: Data were extracted from a cross-sectional nationwide campaign involving healthy children aged 1-5 years conducted over a 4-month period in 2019. We obtained information on demography, parental height and risk factors of undernutrition and anthropometric measurements (height and weight) of children enrolled. Age and sex-specific z-score for length/height-for-age (HAZ), weight-for-age (WAZ), body mass index (BMI) z-score (BAZ) and weight-for-height/length (WFH) z-score (WFHZ) were obtained using World Health Organization growth standards. The following definitions were used: (a) HAZ < -2 SD as stunted and -2 to -1 SD as at risk of stunting; (b) WFHZ < -3 SD as severe, -3 to < -2 SD as moderate wasting, and -2 to < +1 SD as normal; (c) WAZ -2 to -1 as at risk of underweight; (d) BAZ +1 to < +2 SD as at risk of and > +2 SD as overweight.

Results: Of the 15,331 children surveyed, prevalence of stunting and at risk of stunting were 16.1 and 20.0%, severe and moderate wasting were 4.0 and 6.1%, while 21.1% was at risk of underweight. Prevalence of at risk of and overweight 14.2 and 7.3%, respectively. One in fifth (25.0%) children had at least one form of undernutrition (stunting and/or underweight/wasting). Of the 1,412 (13.2%) children reported to have risk factors of undernutrition, 47.2% had feeding difficulties, 44.8% had poor dietary intake and 8.0% had both. Boys, paternal height < 156 cm and poor dietary intake were significantly associated with stunting and/or wasting. Compared with children with no risk factors, children with feeding difficulties were more likely to be wasted (AOR: 1.48, 95% CI: 1.18-1.85), and had at least one form of undernutrition (AOR: 1.45, 95% CI: 1.25-1.69).

Conclusions: In Malaysian children aged 1 to 5 years, dual burden of under- and overnutrition are common. Poor dietary intake and feeding difficulties were risk factors for undernutrition.

Keywords: at risk of undernutrition; prevalence; risk factors; stunting; undernutrition; wasting; young children.