Tackling Micronutrient Deficiencies: Causes and solutions Wan Abdul Manan Wan Muda, for Wan Abdul Manan Wan Muda, Jomo KS and Tan Zhai Gen 1st October 2019
+ Tackling Micronutrient Deficiencies: Causes and solutions Micronutrient Nutrition • Micronutrients – also known as vitamins and minerals – are essential components of a high-quality diet and have a profound impact on health. Required only in tiny quantities, however they are essential building blocks of healthy brains, bones and bodies. • Micronutrient deficiencies are often referred to as ‘hidden hunger’ because they develop gradually over time, their devastating impact not seen until irreversible damage has been done • Millions of children suffer from stunted growth, cognitive delays, weakened immunity and disease as a result of micronutrient deficiencies.
+ Tackling Micronutrient Deficiencies: Causes and solutions Common Micronutrient Deficiencies • Iodine deficiency - can lead brain damage in children, particularly, during fetal development and in the first few years of a child’s life. • Vitamin A deficiency - weakens the immune system and increases a child’s risk of contracting and dying from infections like measles, and diarrhoeal illnesses. • Iron deficiency - anemia, risk of hemorrhage during childbirth can lead to maternal deaths. Risk of babies born prematurely, vulnerable to infections, learning disabilities, and delayed development. • Zinc deficiency - impairs immune function and risk of gastrointestinal infections which can lead to mortal diarrhea. • Calcium, vitamin D, and folate deficiencies are of concern during pregnancy, risk of health complications for both the mother and growing baby.
+ Tackling Micronutrient Deficiencies: Causes and solutions Micronutrients intake Source : Bee Koon P et al. (2013).Nutritional status 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 doi:10.1017/S0007114513002092
+ Tackling Micronutrient Deficiencies: Causes and solutions Micronutrient Requirements • The dietary requirement for a given micronutrient is defined as the level which meets criteria for being adequate to minimise risk of nutrient deficit or excessive intake. • Nutrient requirements vary between individuals based on a range of factors, including age, sex, physical activity levels, and can be higher during periods of pregnancy, lactation, and disease. • The UN Food and Agricultural Organization (FAO) and World Health Organization (WHO) publish tables of nutrient requirement values across demographic groups
+ Tackling Micronutrient Deficiencies: Causes and solutions Micronutrient Nutrition Micronutrient deficiency is more prevalent in countries with poor dietary diversity • To ensure adequate micronutrient intake through dietary intake alone (with the use of fortified, processed foods), a diverse diet is required. • Micronutrient-rich foods include fruit and vegetables , meat and dairy , pulses , seafood, nuts and seeds . • In contrast, cereal, root and tuber commodities tend to be energy- dense but micronutrient-poor. • In the chart below we have plotted the hidden hunger index in children (on the y-axis) versus the share of dietary energy attained through the consumption of cereals, roots and tubers. Overall, we see that countries where the average diet is rich in micronutrient- poor cereals tend to have higher levels of micronutrient deficiency (here shown as hidden hunger in children).
+ Tackling Micronutrient Deficiencies: Causes and solutions
+ Tackling Micronutrient Deficiencies: Causes and solutions Nutrient intakes as a percentage of children’s Recommended Nutrient Intake 29.9 Calcium 41.3 90.1 Iron 92.3 53.4 Thiamin 58.9 89.1 Riboflavin 83.7 63.1 Niacin 76.2 55.7 Vitamin C 58.1 90.1 Vitamin A 92.3 0 20 40 60 80 100 Girl Boy Source: Nutrition Society of Malaysia, 2015
+ Tackling Micronutrient Deficiencies: Causes and solutions Urinary iodine level (µg/L) in Malaysia by state, 2008 Perlis 115.2 Kedah 85.2 Penang 85.8 Perak 77.8 Selangor 126 Negeri Sembilan 120.8 Malacca 125.5 Johor 118 Recommended minimum Pahang 76.5 iodine level of 100 µg/L Terengganu 78.7 Kelantan 76.9 Sabah 150.2 Sarawak 101.9 WP Kuala Lumpur 131 WP Putrajaya 207 WP Labuan 140.7 0 50 100 150 200 250 Source: Wan Nazaimoon & Rusidah, 2010
+ Tackling Micronutrient Deficiencies: Causes and solutions Population affected by anaemia by age group, 2015 Elderly men 8% Elderly women 10% Men 15-59 years 23% Women 50-59 years 8% Women 15-45 years 51% Total population 4.9 million (95% CI 4.6-5.1) Source: NHMS 2015, as reported by Awaluddin, et al., 2017
+ Tackling Micronutrient Deficiencies: Causes and solutions Prevalence of anaemia (Hb, 11gm) among pregnant mothers at the 36th week of gestation who attended government health facilities, 2004 – 2015 45 38.3 40 35 32.6 28.9 30 Prevalence (%) 26.7 24 25 21.5 20.8 20 16.2 14 15 11.8 9.3 8.2 10 5 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year Source: Health Information Centre, Ministry of Health, Malaysia
+ Tackling Micronutrient Deficiencies: Causes and solutions Prevalence of Vitamins and Minerals Supplement Uses Malaysian Adults – Total – 28.05% Men – 24.29% Women – 32.12% Type of Supplements: Vitamin C 15.68% Multivitamin and multimineral 8.87% Calcium 5.84% Vitamin B-complex 5.62% Folic Acid 2.70% Vitamin E 2.62% Iron 2.06 Zinc 1.32 Vitamin A NA Vitamin B12 0.78
+ Tackling Micronutrient Deficiencies: Causes and solutions Intake of Fruits and Vegetables WHO recommendations: 5 servings per day (Fruits = 2 servings, Vegetables = 3 servings) About 10% of Malaysian adults met the WHO recommendations Adequate intake of fruits (=2 servings) – 9.9% Adequate intake of vegetables (=3 servings) – 11.2% (NHMS 2015) Top 5 Vegetables and Fruits consumed by Malaysian adults (MANS 2014) Vegetables Prevalence Fruits Prevalence Green leafy vegetables 66.0% Apple 34.3% Cabbage 19.0% Papaya 21.0% Fruity vegetables 10.8% Orange/mandarin 16.3% Seedy vegetables 10.7% Banana 15.3% Tuber vegetables 10.5% Guava 14.4%
+ Tackling Micronutrient Deficiencies: Causes and solutions Prevention and treatment of micronutrient deficiency If micronutrient requirements cannot be met through dietary intake alone (for example if households do not have access to or cannot afford the dietary diversity required) common strategies to address deficiencies are: Supplementation : supplementation is the delivery of • concentrated micronutrients in pill, powder or liquid form; • Food fortification : fortification is a subset of food processing and involves the addition of small amounts of micronutrients to food products (such as cereals, wheat flours and rice); • Biofortification : the use of agronomic and plant- breeding approaches in agriculture to increase the concentration of micronutrients in staple food crops. The most well-known example is so- called ‘ golden rice ‘, which is rice grown with high concentrations of vitamin-A.
+ Tackling Micronutrient Deficiencies: Causes and solutions PILIHAN PAKEJ Pakej 1 Pakej Pakej Pakej Pakej Pakej Pakej Pakej Pakej Pakej Pakej Pakej Pakej JENIS 2 3 4 5 6 7 8 9 10 11 12 13 MAKANAN √ √ √ √ √ √ Beras (5 kg) √ √ √ √ √ √ Bihun (2.8-3 kg ) √ √ √ √ √ √ √ √ √ √ √ √ Susu Tepung Penuh Krim (1.8 -2 kg) √ √ √ √ √ √ √ √ √ √ √ √ Bijirin Sarapan (0.9-1 kg) √ √ √ √ √ √ √ √ √ √ √ √ Biskut (1.8-2 kg) √ √ √ √ Telur (30 biji) √ √ √ √ Ikan sardin (7 tin kecil:155g/tin) √ √ √ √ Ikan bilis (500 g) √ √ √ √ √ √ Marjerin (240-250g) √ √ √ √ √ √ Minyak Masak (1 kg) √ √ √ √ √ √ √ √ √ √ √ √ Serbuk Malt Coklat (1 kg) √ √ √ √ √ √ √ √ √ √ √ √ √ Multivitamin (30/ 60 biji atau 50-120ml) √ Susu Khas/ Susu Formula (1.6-2 kg)
+ Tackling Micronutrient Deficiencies: Causes and solutions National Plan of Action on Nutrition Malaysia III
+ Tackling Micronutrient Deficiencies: Causes and solutions National Plan of Action on Nutrition Malaysia III
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