National Plan of Action for Nutrition of Malaysia III (2016-2025)

National Coordinating Committee on Food and Nutrition (NCCFN) M I N I S T R Y O F H E A L T H M A L AY S I A National Plan of Action for Nutrition of Malaysia III 2016-2025 ii National Plan of Action for Nutrition of Malaysia III, 2016-2025 ISBN: 978-967-0769-64-6 First Published in Malaysia 2016. Copyright © Nutrition Division, 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 any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission from the publisher. Application for such permission should be addressed to the Director of Nutrition Division, Ministry of Health. Published by: National Coordinating Committee on Food and Nutrition (NCCFN). c/o Nutrition Division Ministry of Health, Malaysia Level 1, Block E3, Complex E Federal Government Administration Centre 62590 Putrajaya, MALAYSIA Printed by: Aslita Sdn. Bhd. (146102 U) No. 10 & 12, Jalan 2/10B Spring Crest Industrial Park Wilayah Persekutuan Kuala Lumpur 68100 Batu Caves, W.P Kuala Lumpur, MALAYSIA CONTENT Foreword Foreword by Minister of Health Malaysia Foreword by Secretary General Foreword by Director General of Health Foreword by Chairman of National Coordinating Committee on Food and Nutrition (NCCFN) Foreword by Director of Nutrition Division 1.0 Executive Summary 2.0 Introduction 3.0 Nutritional Status, Dietary Practices and Physical Activity Status of the Population 3.1 Background 3.2 Body Weight and Height Status 3.3 Status of Selected Vitamins and Mineral Intake 3.4 Risk Factors of Non-Communicable Diseases (NCDs) 3.5 Dietary Practices 3.6 Physical Activity Status 4.0 Food and Nutrition-Related Policies and Action Plan 5.0 Current Nutrition Programmes and Activities 5.1 Background 5.2 Nutrition Programmes and Activities Related to Pregnant Women and Infants 5.3 Nutrition Programmes and Activities for Children 6 Years and Below 5.4 Nutrition Programmes and Activities for Children with Special Needs 5.5 Nutrition Programmes and Activities for School Children 5.6 Nutrition Programmes and Activities for Adolescents 5.7 Nutrition Programmes and Activities for Adults 5.8 Nutrition Programmes and Activities for Elderly 5.9 Other Nutrition Programmes and Activities 6.0 Achievements and Challenges of the NPANM II, 2006-2015 6.1 Background 6.2 Achievements of NPANM II, 2006-2015 6.3 Challenges of NPANM II, 2006-2015 7.0 Moving Forward in the NPANM III, 2016-2025 8.0 Framework of the NPANM III, 2016-2025 v vi vii viii ix 2 3 5 6 7 10 12 13 14 15 27 28 29 33 34 34 36 36 38 38 41 42 44 53 55 61 iii National Plan of Action for Nutrition of Malaysia III, 2016-2025 iv National Plan of Action for Nutrition of Malaysia III, 2016-2025 9.0 Indicators of the NPANM III, 2016-2025 • Indicator 1 : Promoting Maternal, Infant and Young Child Nutrition • Indicator 2 : Promoting Healthy Eating and Active Living • Indicator 3 : Preventing and Controlling Nutritional Deficiencies • Indicator 4 : Preventing and Controlling Obesity and Other Diet-related Non-Communicable Diseases (NCDs) 10.0 Activities by Strategies Foundation Strategy Incorporating Nutrition Objectives, Considerations and Components into National Development Policies and Action Plans Enabling Strategies • Enabling Strategy 1 : Promoting Maternal, Infant and Young Child Nutrition • Enabling Strategy 2 : Promoting Health Eating and Active Living • Enabling Strategy 3 : Preventing and Controlling Nutritional Deficiencies • Enabling Strategy 4 : Preventing and Controlling Obesity and other Diet-related Non-Communicable Diseases (NCDs) • Enabling Strategy 5 : Sustaining Food Systems to Promote Healthy Diets • Enabling Strategy 6 : Supporting Efforts to Promote Food Safety and Quality Facilitating Strategies • Facilitating Strategy 1 : Providing Standard Nutrition Guidelines for Various Targeted Groups • Facilitating Strategy 2 : Continuous Assessment and Monitoring of the Nutrition Situation • Facilitating Strategy 3 : Strengthening Food and Nutrition Research and Development • Facilitating Strategy 4 : Ensuring Sufficient Number of Qualified Nutritionists and Dietitians • Facilitating Strategy 5 : Strengthening Institutional and Community Capacity for Nutrition 11.0 Mechanism of Implementation, Monitoring and Evaluation of the NPANM III, 2016-2025 References Appendices a) The NPANM III, 2016-2025 Drafting Committee b) The NPANM III, 2016-2025 Editorial Committee c) List of Abbreviations 67 69 73 76 79 85 87 87 91 93 99 111 115 119 125 129 131 135 137 141 145 149 152 155 156 160 161 FOREWORD BY MINISTER OF HEALTH MALAYSIA The National Plan of Action for Nutrition ofMalaysia (NPANM) III, 2016-2025 representsMalaysia’s continued commitment to the Rome Declaration on Nutrition adopted by the International Conference on Nutrition (ICN) in 1992 and 2014. De NPANM III, 2016-2025 is the master plan to achieve optimal nutritional well-being of Malaysians. Covering the period of 2016 to 2025, the NPANM III addresses both nutritional deCciencies and diet-related non-communicable diseases (NCDs) in the country. For several decades, key international agencies, especially the World Health Organization (WHO) and Food and Agriculture Organization (FAO) have highlighted the importance of promoting optimal nutrition of the community. In 2014, United Nations General Assembly and World Health Assembly made a political declaration on the importance of preventing and controlling NCDs. In line with these international commitments, the government of Malaysia has given due recognition to the importance of NPANM III, 2016-2025 in the Eleventh Malaysia Plan (2016-2020). Prevention and control of nutrition challenges require the collaboration of multiple stakeholders. As such, the NPANM III, 2016-2025 calls for all stakeholders in the country to incorporate nutrition strategies into their respective programmes for improving the nutritional status of the population. Towards this end, it is imperative to further establish and strengthen the national coordinating mechanism on food and nutrition. It is my fervent hope that the NPANM III, 2016-2025 will be implemented with the full support and collaboration from various stakeholders. YB Datuk Seri Dr. S.Subramaniam Minister of Health Malaysia v National Plan of Action for Nutrition of Malaysia III, 2016-2025 vi National Plan of Action for Nutrition of Malaysia III, 2016-2025 FOREWORD BY SECRETARY GENERAL Iam pleased to note that the National Plan of Action forNutrition of Malaysia (NPANM) III, 2016-2025 hasbeen drafted with the consultation and collaboration of various ministries and government agencies, institutions, academia, professional bodies, non-government organisations (NGOs) and the private sector. To accomplish the overall goal of NPANM III, 2016-2025, it is vital for relevant ministries and agencies to incorporate nutrition strategies into their policies and programmes. Dis multi stakeholder and multi-sectoral approach will ensure better coverage of strategies and activities to promote optimal nutritional well-being of Malaysians. I would like to record my thanks to all stakeholders for their valuable input in developing NPANM III, 2016-2025. I believe the NPANM III, 2016-2025 is a crucial framework for the implementation of nutrition programmes and activities in the country. In this regard, I would like to urge all stakeholders to devote adequate resources so as to eBectively implement the identiCed activities in the Plan. YBhg. Dato’ Seri Dr. Chen Chaw Min Secretary General Ministry of Health Malaysia FOREWORD BY DIRECTOR GENERAL OF HEALTH The National Plan of Action for Nutrition ofMalaysia (NPANM) III, 2016-2025 was draftedtaking into cognisance the nutrition situation in the country as well as international and regional food and nutrition development. Under-nutrition continues to be a problem in certain segments of our population. At the same time over-nutrition has contributed to the high prevalence of diet-related non-communicable diseases. Recognising the existence of this double burden of malnutrition in the country, the NPANM III, 2016-2025 has formulated strategies to prevent and control these nutrition disorders. In line with the objectives of the National Nutrition Policy of Malaysia, a multi-stakeholder and multi-sectoral approach have been adopted to formulate the NPANM III, 2016-2025. Embracing a “whole-of-government” approach, the NPANM III, 2016-2025 takes into consideration the plans of action of various ministries and agencies including agriculture, education, women, family and community development, consumer advocacy, youth and sports, welfare, housing and local government, rural and urban development. Valuable input has been obtained from academia, professional bodies, and non-governmental organisations. Public-private partnership is also recognised to play an important role in achieving the objectives of the Plan. I would like to express my utmost gratitude to the National Coordinating Committee on Food and Nutrition (NCCFN) and the NPANM III, 2016-2025 Working Groups for their active contributions. I would like to thank the Nutrition Division of the Ministry of Health Malaysia for providing the necessary secretariat and technical support for driving the successful preparation of this Plan. Y.Bhg. Datuk Dr. Noor Hisham Abdullah Director General of Health Ministry of Health Malaysia vii National Plan of Action for Nutrition of Malaysia III, 2016-2025 viii National Plan of Action for Nutrition of Malaysia III, 2016-2025 FOREWORD BY CHAIRMAN OF NATIONAL COORDINATING COMMITTEE ON FOOD AND NUTRITION (NCCFN) TheNational Coordinating Committee on Food andNutrition (NCCFN) is a high level coordinatingcommittee on food and nutrition in the country to monitor and evaluate the implementation of the National Plan of Action for Nutrition of Malaysia (NPANM) III, 2016-2025. Dis Committee is a platform to discuss issues pertaining to nutrition which need commitment and collaboration from other health sectors. De members of NCCFN consist of representatives from various ministries and government agencies, NGOs, academia and private sector. It is important that the implementation of NPANM III, 2016-2025 be implemented with the guiding principle of close collaboration within the multi-sectoral framework. NPANM III, 2016-2025 recognises that direct nutrition interventions need to be coordinated at all levels of government - Federal, State, and Local Government - with complementary actions to address the underlying determinants of good nutrition: food security, health services, a healthy environment, and adequate care for the nutritionally vulnerable. De strategies identiCed in NPANM III, 2016-2025 will be delivered through three main delivery platforms to ensure that maximum coverage is attained for targeted population: health facility; community structure; and campaigns/ outreach activities. De road ahead is likely to be more if not equally challenging. Undeniably there are still key issues to be resolved particularly implementation issues like convergence of interventions at the district levels, vertical and horizontal integration and coordination, and absorptive capacity of frontline nutrition, health and other development workers. Nevertheless, with all of us joining hands, I believe that we will be able to achieve the targeted indicators. Datuk Dr. Lokman Hakim bin Sulaiman Deputy Director General of Health (Public Health) Ministry of Health Malaysia Chairman of NCCFN FOREWORD BY DIRECTOR OF NUTRITION DIVISION First of all, I would like to thank all drafting committeemembers of the National Plan of Action forNutrition of Malaysia (NPANM) III, 2016-2025 for their great eBort in drafting the Plan. De Crst coordinated nutrition programme in the country began with the establishment of the Applied Food and Nutrition Programme (AFNP) implemented in 1970s. In 1974, the Crst nutritionist was employed by the Ministry of Health (MOH), Malaysia. Since then, the nutrition programs and activities evolved in the country. De evolvement also involves nutrition in the MOH from being a unit within the Family Health Development Section to being a Nutrition Section in 1990. It is now standing a division in the MOH since October 2009. Towards making this plan a reality, Nutrition Division is resolved to spearhead and coordinate the implementation of the identiCed strategies and activities of NPANM III, 2016-2025.De Division will work with other stakeholders, including professional bodies and NGOs, academia and private sector in achieving the goals and objectives of the Plan. In order to make the Plan a reality, the cooperation from all parties including governmental or non-governmental organisations is indispensable. Implementation of activities on the basis of not only the extent, but it should be realised from the grassroots level. Derefore, I would like to thank once again for the eBorts and commitments given by all parties involved, starting from the formation of this document until it is implemented within the next decade. Zalma Abdul Razak Director of Nutrition Division Ministry of Health Malaysia ix National Plan of Action for Nutrition of Malaysia III, 2016-2025 x National Plan of Action for Nutrition of Malaysia III, 2016-2025 1 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Executive Summary 1.0 Executive Summary 2 National Plan of Action for Nutrition of Malaysia III, 2016-2025 T he National Plan of Action for Nutrition Malaysia (NPANM) is the framework for action to address food and nutrition challenges in the country. The NPANM series are Malaysian’s commitment towards the Rome Declaration on Nutrition arising from the International Conference on Nutrition (ICN 2) held in 1992 and 2014. The NPANM III, 2016-2025 is the sequels of the NPANM I, 1996-2000 and NPANM II, 2006-2015. The development of the NPANM III, 2016 2025 is spearheaded by the Ministry of Health under the purview of the National Coordinating Committee of Food and Nutrition (NCCFN), with active participation and consensus from all stakeholders in food and nutrition in the country. These include relevant ministries and government agencies, research institutions, academia, professional bodies, non-government organisations including consumer groups and food industries. The Plan was drafted taking into cognisanse of the nutrition situation in the country as well as international and regional food and nutrition development. It underlines the importance of nutrition in enhancing population health, preventing diet related diseases and strengthening food and nutrition security. The Plan has identified (46) nutrition indicators and set targets to be achieved by 2025 under following specific areas; Promoting Maternal, Infant and Young Child Nutrition (10); Promoting Healthy Eating and Active Living (11); Preventing and Controlling Nutritional Deficiencies (9) and Preventing and Controlling Obesity and Diet-related NCDs (16). To achieve the targets, the Plan has proposed 3 main strategies, namely Foundation Strategy; Enabling Strategies and Facilitating Strategies. The Ministry of Health Malaysia is responsible for monitoring the implementation of all activities indicated in the Plan through the National Coordinating Committee for Food and Nutrition (NCCFN). Under this committee, there are 6 Technical Working Groups (TWGs) for Nutrition. They are TWG Policy, TWG Dietary Guidelines, TWG Training, TWG Research, TWG Promotion and TWG Food and Nutrition Security (newly established). These provide the platforms for different stakeholders to work together towards common aims and objectives and also to ensure coordinated and sustained actions. Hence, for sustainable impact, a concerted effort through multi-stakeholder engagements including public, private and civil society stakeholders in a systematic way to comprehensively promote healthy eating and active living is greatly warranted to effectively ensure the health of population. Advocacy of the NPANM III, 2016-2025 will be carried out to all relevant stakeholders to get better support and commitment in ensuring effective implementation of the identified activities. The overall achievements of the NPANM III, 2016-2025 will be reviewed during midterm (2020) and by the end of the Plan (2025). 3 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Introduction 2.0 Introduction 4 National Plan of Action for Nutrition of Malaysia III, 2016-2025 The National Plan of Action for Nutrition of Malaysia (NPANM) is the framework for action to address food and nutrition challenges in the country. It is the nation’s blue print to promote optimal nutritional well-being of Malaysians through a series of strategies and activities. The Plan underscores the importance of nutrition in enhancing population health and preventing diet related diseases. Decreasing the occurrence of nutritional deficiencies and diet-related chronic diseases, will lead to increased productivity of the population. Improving nutritional well-being of the population is also known to reduce the health care burden of the nation. The NPANM series is Malaysia’s commitment towards the Rome Declaration on Nutrition arising from the International Conference on Nutrition (ICN) held in 1992 and 2014. The NPANM III (2016 2025) is the follow-up of the NPANM I (1996 – 2000) and NPANM II (2006 – 2015). The targets and strategies of the NPANM III are in accordance with the international guidelines, especially those from WHO, UNICEF and FAO, as well as Malaysia Development Plan, Ministry of Health Strategic Plan and other national policies and programmes in various ministries and agencies. Based on a detailed analysis of the nutrition situation in the country, the NPANM III has been drafted to address the persistence of the double burden of malnutrition. While under-nutrition will continue to be addressed, emphasis is also accorded to the rising prevalence of obesity and the non-communicable diseases (NCDs). The development of the NPANM III was spearheaded by the Ministry of Health under the purview of the National Coordinating Committee for Food and Nutrition (NCCFN). It has been carried out with active participation and consensus from stakeholders in food and nutrition in the country. These include relevant ministries and government agencies, research institutions, academia, professional bodies, non-government organisations and private sector such as food industries. 2.0 INTRODUCTION 5 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Nutritional Status, Dietary Practices and Physical Activity Status of the Population 3.0 3.0 NUTRITIONAL STATUS, DIETARY PRACTICES AND PHYSICAL ACTIVITY STATUS OF THE POPULATION 6 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Malaysia has enjoyed one of the best economic growth records in Asia over the last five decades. The economy achieved a stable real GDP growth of 6.2% per annum since 1970, successfully transforming from a predominantly agriculture-based economy in the 1970s, to manufacturing in the mid-1980s, and to modern services in the 1990s. In addition, this country rose from the rank of a low-income economy in the 1970s to a high middle- income economy in 1992 and remains so today. Malaysia’s national per capita income expanded more than 25-fold from US$402 (1970) to US$10,796 (2014) (11th MP) and is well on track to surpass the US$15,000 threshold of a high–income economy by 2020. In recent decades, Malaysia has experienced a rapid phase of industrialisation and urbanisation. The rapid demographic and nutrition transition towards achieving a developed economy status has inevitably generated marked changes in dietary habits and lifestyles of Malaysians. This changes are associated with changes in nutrition and health status, and increased prevalence of chronic diseases and non-communicable disease in the population. This chapter summarises the current nutritional status, the main nutritional problems, the dietary practices as well as the physical activity status of the population. Based on a detailed analyses of this information, the strategies and action plans of NPANM III, 2016-2025 have been formulated. 3.1 Background Nutritional Status of Children Below 5 Years (WHO, 2006) 20 18 16 14 12 10 8 6 4 2 0 2006 2015 17.2 Underweight (WAZ <-2SD) Stunting (HAZ<-2SD) Wasting (WHZ<-2SD) 13.9 12.9 6.4 8.0 17.7 12.4 7.6 Overweight (BAZ>2SD) Source: NHMS 2006 & NHMS 2015 P re va le n ce (% ) 7 National Plan of Action for Nutrition of Malaysia III, 2016-2025 School Aged Children Figure 2 : Prevalence of Thinness (BMI for age < -2SD) by Age Groups Figure 1 : Nutritional Status of Children Below 5 Years Old (WHO, 2006) 0 2 4 6 8 10 12 14 16 NHMS 2011 NHMS 2015 5-9 13.4 8.7 6.9 9.0 10-14 15-17 P re va le n ce (% ) Age Groups (years old) 11.2 7.0 Source: NHMS 2011 & NHMS 2015 Below 5 Years Old 3.2 Body Weight and Height Status Based on the periodic National Health and Morbidity Survey, Malaysia still faces the double burden of malnutrition, with rising rates of childhood obesity as well as stunting among children. Malaysian children today are growing up in an obesogenic environment that leads to sedentary lifestyle and unhealthy eating habits. Energy imbalance has resulted from this lifestyle, with more time being spent on screen-based activities. Undernutrition among children such as stunting, will lead to obesity and NCDs in later life. 8 National Plan of Action for Nutrition of Malaysia III, 2016-2025 0 2 4 6 8 10 12 14 16 NHMS 2011 NHMS 2015 5-9 10-14 15-17 P re va le n ce (% ) Age Groups (years old) 6.7 6.3 4.9 9.6 14.8 14.4 Source: NHMS 2011 & NHMS 2015 Figure 4 : Prevalence of Obesity (BMI for age > 2SD) by Age Groups 0 2 4 6 8 10 12 14 18 16 NHMS 2011 NHMS 2015 5-9 10-14 15-17 P re va le n ce (% ) Age Groups (years old) 13.8 12.8 16.3 12.7 12.3 11.0 Source: NHMS 2011 & NHMS 2015 Figure 3 : Prevalence of Stunting (Height for age > 2SD) by Age Groups 9 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Nutritional Status of Adults >18 Years Old and Above 35 30 25 20 15 10 5 0 2006 2011 2015 29.1 Obesity (BMI > 30 kg/m2) 14 8.5 29.4 15.1 8.3 30 17.7 6.7 Overweight (BMI 25.0 kg/m2 - 29.9 kg/m2) Underweight (BMI <18.5 kg/m2) P re va le n ce (% ) Source: NHMS 2006 & NHMS 2015 Figure 5 : Nutritional Status of Adults >18 Years Old and Above Adults > 18 years old and Above The prevalence of obesity among adults had increased more than three folds from 1996 (4.5%) to 2006 (14%). However, Malaysians have taken considerable concerted measures to mitigate the increase in obesity prevalence. This is proven by the findings of the NHMS 2011, where the increase of adult obesity prevalence was only 1.1% from 2006. However, the challenges to mitigate obesity prevalence continue in 2015 where the increase rate was 2.6% compared to 2011 data. 10 National Plan of Action for Nutrition of Malaysia III, 2016-2025 3.3 Status of Selected Vitamins and Mineral Intake 0 5 10 15 20 25 30 35 40 % 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 38.3 32.6 28.9 26.7 24.0 21.5 20.8 16.2 14.0 11.8 9.3 8.2 Hb < 11 gm% Source: Health Informatics Centre, MOH Pregnant women Children Figure 6 : Anaemia amongst pregnant women at 36 weeks of gestation The status of anaemia among pregnant mothers is monitored based on the haemoglobin (Hb) level of pregnant women at 36 weeks gestation who attended the government health clinics. The percentage of pregnant women with anaemia reduced from 38.3% (2004) to 8.2% (2015). Based on the WHO classification of public health significance, anaemia still poses a mild public health problem to the country. Based on the Nutrition Survey of Malaysian Children (SEANUTS) findings, only a small proportion of children had low levels of Hb (6·6 %), serum ferritin (4·4 %) and vitamin A (4·4 %), but almost half the children (47·5 %) had vitamin D insufficiency. The National IDD (Iodine Deficiency Disorder) Survey 2008 showed that about half (50.7%) of the school children aged 8-10 years old in Peninsular Malaysia had Iodine Deficiency Disorder. In addition, MyBreakfast Study of School Children 2013 showed that more than 50% of the school-aged children achieved at least 80% of the Recommended Nutrient Intake (RNI) for vitamin A, vitamin C, niacin, riboflavin, thiamine and iron. However for calcium intake, only 29.9% girls and 41.3% boys achieved the recommended intake. Figure 7 : RNI achievement of selected micronutrients among school children aged 6-17 years old 0 Vitamin A Boy 92.3 90.1 83.7 89.1 76.2 63.1 58.1 55.7 58.9 53.4 92.3 90.1 41.3 29.9 Vitamin C Niacin Riboflavin Thiamin Iron Calcium 10 20 30 40 50 60 70 80 90 100 Girls Source: MyBreakfast Study of School 2013 In addition, MyBreakfast Study of School Children, 2013 showed that more than 50% of the school-aged children achieved at least 80% of the Recommended Nutrient Intake (RNI) for vitamin A, vitamin C, niacin, riboflavin, thiamine and iron. For calcium, only 29.9% girls and 41.3% boys achieved this recommended intake. 11 National Plan of Action for Nutrition of Malaysia III, 2016-2025 12 National Plan of Action for Nutrition of Malaysia III, 2016-2025 3.4 Risk Factors of Non-Communicable Diseases (NCDs) Prevalence of NCDs > 18 Years Old and Above P re va le n ce (% ) 60 50 40 30 20 10 0 2006 2011 2015 20.7 Source: NHMS 2006, NHMS 2011 & NHMS 2015 32.2 11.6 35.1 32.7 15.2 47.7 30.3 17.5 Hypercholesterolemia Hypertension Diabetes Mellitus Figure 8 : Prevalence of NCD >18 Years Old and Above As shown in Figure 8, the prevalence of hypertension had increased slightly from 32.2% in 2006 to 32.7% in 2011, but decreased to 30.3% in 2015. The prevalence of hypercholesterolemia had doubled from 20.7% in 2006 to 47.7% in 2015. The prevalence of diabetes mellitus has also increased in the space of 10 years from 11.6% in 2006, to 17.5% in 2015. This has resulted in escalating social and economic costs and other problems arising from these diseases. It is therefore important that efforts to develop cost effective nutrition programmes to prevent and combat nutrition-related diseases in Malaysia be identified as a priority. 3.5 Dietary Practices Infants and Young Children Infant feeding practices comprising breastfeeding and complementary feeding have major roles in determining the nutritional status of the child. The NHMS 2006 showed that 14.5% children were breastfed exclusively for 6 months. However, based on clinic data, this rate had increased from 14.4% in 2009 to 49.4% in 2015 (SHD, MOH 2015). The Malaysian Population and Family Survey (MPFS, LPPKN 2014) also reported that below 6 months exclusive breastfeeding rate was 43.5%. Whilst, percentage of early initiation was 63.7% (NHMS 2006) and 94.7% mothers are reported ever breastfed their babies. However, only 41.5% infants received timely complementary feeding and complementary food was given to infants as early as two months of age. Furthermore, only 55.9% children aged 9 23 months received at least 3 meals a day (NHMS 2006). However, data from clinics showed that timely introduction of complementary feeding was improved from 64.6% in 2009 to 92.2% in 2015 (SHD, MOH 2015). Children and Adolescents The Malaysia School-Based Nutrition Survey 2012 showed that about 93.7% of adolescents consumed vegetables below the recommendation of 3 servings/ day whilst 51.7% consumed fruits below recommendation of 2 servings/ day. For milk and dairy products consumption, 81.5% consumed below the recommended 1-3 servings/ day. MyBreakfast Study of School Children in 2013, showed that 24.6% of school children (aged 6-17 years old) skipped breakfast ≥ three days per week. Only 25% of primary school and 19% of secondary school children consumed whole grains and almost all the children (97.7%) did not consume adequately. Therefore, there is a need to address healthy eating practices as early as possible. Adults Malaysian Adult Nutrition Survey (MANS) 2014 showed that 59.1% consumed fruits below the recommended 2 servings/ day and 81.7% consumed vegetables below the recommended 3 servings/ day. For milk and dairy products consumption, 73.6% consumed below the recommendation of 1-3 servings/ day. A similar pattern can also be seen for the intake of legumes and nuts whereby 81.9% consumed below the recommended 1/2 servings /day. It is also reported that, almost half (45.6%) of adults exceed the recommended intake of fat and half (50.7%) exceed the recommended intake of protein. On the other hand, 53.5% consumed carbohydrates less than the recommended amount. 13 National Plan of Action for Nutrition of Malaysia III, 2016-2025 14 National Plan of Action for Nutrition of Malaysia III, 2016-2025 3.6 Physical Activity Status It is generally agreed that a healthy diet and an active lifestyle are important determinants of health status and nutritional well-being. Based on the NHMS 2011, almost one in two Malaysian adults (44.5%) were engaged in low physical activity levels. Findings of the MANS 2014 indicated approximately 7.1 million Malaysian adults were physically inactive, representing 36.9% of the adult population aged 18 to 59 years old. The prevalence of physical inactivity was about the same in the NHMS 2011 (35.7%). Not much difference was observed in NHMS 2015 findings. There was only 2.2% reduction in the prevalence of physically inactivity (33.5%) compared to NHMS 2011 findings. According to Malaysia School- Based Nutrition Survey 2012, 57.3% of adolescents aged 10-17 years were physically inactive. 33.5% Malaysian adults were physically inactive (NHMS 2015) 57.3% of adolescents aged 10-17 years were physically inactive (Malaysia School-Based Nutrition Survey 2012) 36.9% of the adult population were physically inactive (MANS 2014) 15 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Food and Nutrition-Related Policies and Action Plan 4.0 GLOBAL Global Nutrition Targets 2025 Global Monitoring Framework for Maternal, Infant and Young Child Nutrition The Rome Declaration on Nutrition and Framework for Action of the Second International Conference on Nutrition (ICN 2) 2014 The Sustainable Development Goals (SDGs) 2030 To Improve maternal, infant and young child nutrition TARGETS 202 5 16 National Plan of Action for Nutrition of Malaysia III, 2016-2025 ASEAN Integrated Food Security (AIFS) Framework & Strategic Plan of ASEAN on Food Security in the ASEAN region 2015-2020 Action Plan To Reduce Double Burden of Malnutrition in the Western Pacific Region 2015-2020 Global Action Plan for the Prevention & Control of NCDs 2013-2020 This section highlights the policy documents of several international agencies that have been used as references in the formulation of the NPANM III, 2016-2025. These documents have been used in setting target for each indicator. 17 National Plan of Action for Nutrition of Malaysia III, 2016-2025 S T U N TI NG 1 W A S TI NG 6 A N A EM IA 2 L O W BI RT H WEIGHT 3 O V E RW EIG HT 4 B R E AS TF EEDING 5 Global Nutrition Targets 2025 Recognising that accelerated global action is needed to address the double burden of malnutrition, in 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition which specified a set of six global nutrition targets by 2025. Since their adoption at the 65th World Health Assembly, the global nutrition targets have helped the global community to focus on priority areas in improving the nutritional status of mothers, infants and young children. To reduce malnutrition in all its forms, these efforts must continue beyond 2025. Achieve a 40% reduction in the number of children under-5 who are stunted Ensure that there is no increase in childhood overweight Reduce and maintain childhood wasting to less than 5% Achieve a 50% reduction of anaemia in women of reproductive age Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% Achieve a 30% reduction in low birth weight 18 National Plan of Action for Nutrition of Malaysia III, 2016-2025 19 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Global Monitoring Framework for Maternal, Infant and Young Child Nutrition The Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (MIYCN) was endorsed by the Sixty-fifth World Health Assembly (WHA) in May 2012. The WHA resolution urges Member States to put the MIYCN Plan into practice by including proven nutrition interventions relevant to the country in maternal, child and adolescent health services and care. Interventions carried out should ensure universal access, and establish and engage policies in agriculture, trade, education, social support, environment and other relevant sectors to improve nutrition. The MIYCN include six global nutrition targets to be achieved by 2025 and also proposes five actions to support the achievement of the global targets. At the 68th WHA in May 2015, another 14 additional core indicators for MIYCN had been endorsed which included five outcome indicators, six process indicators and three on policy environment and capacity indicators. Stimulate development policies and programmes outside the health sector that recognize and include nutrition. Create a supportive environment for the implementation of comprehensive food and nutrition policies. Monitor and evaluate the implementation of policies and programmes. Provide sufficient human and financial resources for the implementation of nutrition interventions. Include all required effective health interventions with an impact on nutrition in national nutrition plans. 20 National Plan of Action for Nutrition of Malaysia III, 2016-2025 The Rome Declaration on Nutrition and Framework for Action arising from the Second International Conference on Nutrition (ICN2) 2014 The Second International Conference on Nutrition (ICN2) was a high level inter-governmental meeting focusing on addressing malnutrition in all its forms and identify opportunities to tackle them. The two main outcome documents endorsed by participating governments at the Conference are the Rome Declaration on Nutrition and the Framework for Action, committing world leaders to establish national policies aimed at eradicating malnutrition and transforming food systems to make nutritious diets available to all. Improving nutrition, and ensuring everyone has access to healthy diet, is not the responsibility of an individual alone. Nutrition is a public issue that must be addressed primarily by governments in collaboration with other stakeholders, including civil society, the private sector and academia. Framework for action is established with 7 main nutrition commitments to improve nutrition worldwide. Eradicate hunger and prevent all forms of malnutrition Protect consumers, especially children, from inappropriate marketing and publicity of food Increase investments in effective interventions and actions to improve people’s diets and nutrition at all stages of life Implement coherent public policies across relevant sectors, from production to consumption Make food systems more sustainable Provide consumers with clear nutrition information so they can make informed food choices Protect, promote and support breastfeeding The Sustainable Development Goals (SDGs) 2030 The 2030 Agenda for Sustainable Development, also known as the SDGs, are an inter-governmentally agreed set of targets relating to international development following on from the Millennium Development Goals and build on the sustainable development agenda. The Open Working Group on SDGs developed a proposal consisting of 17 goals with 169 targets covering a broad range of sustainable development issues. This included ending poverty and hunger, improving health and education, making cities more sustainable, combating climate change, and protecting oceans and forests. The second of the seventeen proposed SDGs is “End hunger, achieve food security and improved nutrition, and promote sustainable agriculture” is linked directly with nutrition. Goal 1: No poverty Goal 2: Zero hunger Goal 3: Good health and well-being Goal 4: Quality education Goal 5: Gender equality Goal 6: Clean water and sanitation Goal 7: Affordable and clean energy Goal 8: Decent work and economic growth Goal 9: Industry, innovation, infrastructure Goal 10: Reduced inequalities Goal 11: Sustainable cities and communities Goal 12: Responsible consumption, production Goal 13: Climate action Goal 14: Life below water Goal 15: Life on land Goal 16: Peace, justice and strong institutions Goal 17: Partnerships for the goals 21 National Plan of Action for Nutrition of Malaysia III, 2016-2025 2025 GOAL 25% REDUCTION PREMATURE MORTALITY GLOBAL 2025 TARGET 30% REDUCTION TOBACCO USE GLOBAL 2025 TARGET 10% REDUCTION HARMFUL USE OF ALCOHOL GLOBAL 2025 TARGET 10% REDUCTION PHYSICAL INACTIVITY GLOBAL 2025 TARGET 30% REDUCTION SALT/SODIUM INTAKE GLOBAL 2025 TARGET 25% REDUCTION RAISED BLOOD PRESSURE GLOBAL 2025 GOAL 80% AVAILABILITY OF ESSENTIAL AND BASIC TECHNOLOGIES TO TREAT CVD AND OTHER NCD MEDICINES GLOBAL 2025 TARGET 0% INCREASE DIABETES/ OBESITY 50% GLOBAL 2025 TARGET 50% OF ELIGIBLE PEOPLE RECEIVING DRUG THERAPY AND COUNSELLING TO PREVENT HEART ATTACK AND STROKE Source of icons: World Heart Federation Champion Advocates Programme Global Action Plan for the Prevention & Control of NCDs 2013-2020 The goal of this Plan is to reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at global, regional and national levels so that population reach the highest attainable standards of health and productivity at every age and those diseases are no longer a barrier to well-being or socioeconomic development. Nine (9) Voluntary Global Targets are established aiming at combating premature mortality from the four main NCDs. 22 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1 2 3 4 5 23 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Action Plan To Reduce Double Burden of Malnutrition in the Western Pacific Region 2015-2020 This Plan brings together nutrition-related actions from global and regional guidance documents to address diet related diseases and reduce nutritional risk factors. The Plan aims to achieve eight nutrition targets: the six global nutrition targets and two of the nine voluntary NCD targets – to reduce salt intake and halt the increase in obesity and diabetes. The plan highlights the achievements in reducing undernutrition and the need to halt the rise in overweight, obesity and diet-related NCDs. The action plan recommends 20 actions for both countries and WHO to achieve the following five objectives: Elevate nutrition in the national development agenda Protect, promote and support optimal breastfeeding and complementary feeding practices Strengthen and enforce legal frameworks that protect, promote and support healthy diets Improve accessibility, quality and implementation of nutrition services across public health programmes and settings Use financing mechanisms to reinforce healthy diets ASEAN Integrated Food Security (AIFS) Framework & Strategic Plan of ASEAN on Food Security in the ASEAN Region 2015-2020 To sustain and increase food production To reduce postharvest losses To ensure food safety, quality and nutrition To ensure food stability To ensure food stability To operationalise regional food emergency relief arrangements To promote availability and accessibility to agriculture input 24 National Plan of Action for Nutrition of Malaysia III, 2016-2025 National Nutrition Policy of Malaysia 2005 National Plan of Action for Nutrition of Malaysia II 2006-2015 National Breastfeeding Policy 2006 National Food Safety Policy 2007 Salt Reduction Strategy 2015-2020 Ministry of Health Malaysia Strategic Plan 2016-2020 Ministry of Health Malaysia Plan of Action 2016-2020 Government of Malaysia-UNICEF Country Programme Action Plan 2016-2020 11th Malaysia Plan 2016-2020 National Sustainable Consumption and Production Blueprint 2016-2030 National Agro Food Policy 2011-2020 National Adolescent Health Plan of Action 2015-2020 National Health Policy for the Older Person 2008 LOCAL These are the national blueprints and policies that are used as references in the preparation of NPANM III, 2016-2025. The National Nutrition Policies of Malaysia 2005 will elaborated in this section. 25 National Plan of Action for Nutrition of Malaysia III, 2016-2025 26 National Plan of Action for Nutrition of Malaysia III, 2016-2025 T he National Nutrition Policy of Malaysia (NNPM) was approved by the Cabinet in 2003. The National Nutrition Policy of Malaysia endeavours to achieve and maintain the nutritional well-being of the population. The policy aims at providing access to adequate, nutritious, safe and quality food for all. It promotes and supports strategies for the practice of healthy eating. The policy will integrates and synergises the efforts of relevant stakeholders in planning, implementing and evaluating food and nutrition programmes that are effective and sustainable. The goal of the Policy is to achieve and maintain the nutritional well-being of Malaysians to enable them to contribute effectively towards nation building, in line with Vision 2020. Good nutrition is the foundation for health. Adding up to good health depends on other agencies, which goes beyond its importance for the population to have access to sufficient, nutritious and safe and quality food, and the nutrition knowledge to make informed and healthy dietary choices. While under-nutrition persist, Malaysia is facing challenges related to over-nutrition and diet-related non-communicable diseases (NCDs). Increased prevalence of diet-related NCDs contributes to increase of morbidity, mortality and healthcare costs in the country. The nutritional well-being of the population is influenced by several determinants that cut across the areas of responsibilities of various agencies. The NNPM is aimed at consolidating efforts in combating the double burden of nutritional deficiencies and diet-related NCDs. A nutrition policy will therefore provide the platform for inter-sectoral coordination and synergy towards achieving optimum nutrition for all. It is time to review NNPM to be in tandem with the new direction of NPANM III, 2016-2025. The goal of the policy also needs to be updated, since it will be ended by the year 2020. It is crucial to revise the NNPM strategies, in view of the new nutrition issues and challenges in the country. Effective strategies involving multi-sectoral and trans-sectoral need to be identified in strengthening the NNPM. More intensified activities adopting hard policies are urgently warranted to create supportive environments for promoting healthy eating and active living. In tandem with ICN2, commitment for action towards achieving sustainable food systems for a healthy diet, policy coherence amongst the stakeholders throughout the food supply chain will also be strengthened such as on the following areas: • Increase investments for effective interventions and actions to improve people’s diets and nutrition, including in emergency situations. • Enhance sustainable food systems by developing coherent public policies from production to consumption and across relevant sectors to provide year-round access to food that meets people’s nutrition needs and promote safe and diversified healthy diets. National Nutrition Policy of Malaysia (NNPM) 27 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Current Nutrition Programmes and Activities 5.0 Nutrition throughout the life cycle School Children Pregnant Women Elderly Adults Adolescents Children 6 Years and Below Infants and Young Children 5.0 CURRENT NUTRITION PROGRAMMES AND ACTIVITIES 5.1 Background Nutrition programmes have been implemented in this country since the 1950s. Since mid 1990s, the nutrition programme has expanded and has been strengthened with increasing number of nutritionists. In Ministry of Health Malaysia, the Nutrition Section has been upgraded to the Nutrition Division on 16 October 2009. Under this Division, nutrition programmes are divided into four main components, namely Nutrition Planning, Nutrition Surveillance, Nutrition Rehabilitation and Nutrition Promotion. The nutrition programmes cover all age groups from pregnant women, infant and young children to the elderly. Nutrition programmes and activities carried out in the country is mainly to address both under and over nutrition among the population. 28 National Plan of Action for Nutrition of Malaysia III, 2016-2025 5.2 Nutrition Programmes and Activities Related to Pregnant Women and Infants Good nutrition in the early stages of life is very important in ensuring optimal physical and mental development and long term health of the population. Nutritional issues related to this group include macro and micronutrient deficiencies such as anaemia, iodine deficiency and poor maternal weight gain. Malnutrition among pregnant and lactating mothers has impact on the children’s development. Therefore, programmes and activities targeted to mothers are planned and executed to address nutritional issues affecting this vulnerable group. The concept of the first 1,000 days is also integrated into activities related to maternal nutrition to promote action and improve nutrition for mothers and children. The first 1,000 days refer to the critical period between a woman’s pregnancy and her child’s second birthday. The right nutrition during this first 1,000 days can have a profound impact on a child’s ability to grow, learn and rise out of poverty. 29 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Nutrition Surveillance on Pregnant Women and Infants The objective of nutrition surveillance on pregnant women and infants is to monitor their nutritional status. The indicators used in measuring the progress includes anaemia among pregnant women, six months exclusive breastfeeding and timely introduction of complementary feeding. Nutrition Education for Mothers Nutrition education for pregnant and lactating mothers are carried out in clinics and hospitals. It emphasises the importance of nutrition during pregnancy and lactating, adequate food intake in terms of quantity and quality for pregnant and lactating mothers and infant and young children as well as breastfeeding management. Education on feeding practices of infant and young children has been integrated into public health programmes in the clinics. This include dissemination and providing written materials, postnatal talks and seminar/ training courses for child care. It is well recognised that the period from birth to two years of age is critical for the promotion of optimal growth, brain development as well as health and behavioural development. Nutrition Counselling for Pregnant and Lactating Women Nutrition counselling is carried in health clinics and hospitals. The target groups are pregnant mothers who are anaemic, and/ or do not gain adequate weight, lactating mothers who are anaemic and/ or having problems related to breastfeeding as well as pregnant mothers with gestational diabetes mellitus (GDM) and hypertension. Breastfeeding Promotion Breastfeeding promotion is implemented to support the National Breastfeeding Policy which was formulated in 1993 and revised in 2005. The policy states that all mothers are encouraged to breastfeed their infants exclusively for the first six months and continued up to the age of two years. Complementary foods should be introduced at the age of 6 months. A multi-pronged approach is utilised to promote breastfeeding that includes giving every mother, parent, family, friends and employer the right to information on breastfeeding through mass and social media, public forums and seminars. The thematic World Breastfeeding Week is celebrated every year since 1992. Other than that, efforts are also made to promote and support breastfeeding in public places such as shopping complexes, community centres, business premises and workplaces. 30 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Baby-Friendly Hospital Initiative (BFHI) Baby-Friendly Hospital Initiative (BFHI) is a global initiative by the World Health Organization (WHO) and UNICEF that aims to give every baby the best start in life by creating a health care environment that supports breastfeeding as the norm. In 1998, Malaysia had been recognised by WHO as the third country in the world with 100% government hospitals recognised as baby-friendly. Assessment and re-assessment of BFHI is an on-going activity. Whilst 100% government hospitals have been recognised as baby-friendly, more effort and commitment are needed from private hospitals to attain the baby-friendly status. Baby-Friendly Clinic Initiative (Klinik Rakan Bayi, KRB) Baby-Friendly Initiative Clinic is an initiative that complements the implementation of Baby-friendly Initiative in the hospitals. The objective of KRB is to provide services and environment that support the breastfeeding practices. One of the main reasons for the implementation is because more than 90% of the antenatal and postnatal services are being carried out at maternal and child health clinics. The KRB applies the “Nine Steps to Successful Breastfeeding” at the clinic level. This initiative increases knowledge and skill among mothers, therefore they become equipped before delivery and better prepared to sustain exclusive breastfeeding for the first six months. Breastfeeding Mother Support Groups The establishment of breastfeeding mother support groups is one of the important component in breastfeeding promotion. Since the Baby-Friendly Hospital Initiative (BFHI) was launched in 1992, the “Ten Step to Successful Breastfeeding” requires the BFHI to establish support groups in the hospitals and also extends these to the community. This activity perceives the demand from the public especially from the first time mother to be supported in breastfeeding their child. These groups have empowered women to start and continue with breastfeeding. Code of Ethics for the Marketing of Infant Foods and Related Products The overall aim of the Code is to uphold the supremacy of breast milk; to assist in safe and optimal nutrition of infants by the protection, promotion and support of breastfeeding. It also aims to ensure appropriate marketing, and proper use, when required, of designated products (infant formulas, follow-up formulas, special formulas, feeding bottles, teats and pacifiers) and complementary foods. The main activities under this initiative are vetting of materials related to designated products and complementary food and monitoring the violations of the Code. The Code of Ethics is being reviewed to improve its content and strengthen its implementation in consistence with marketing strategies by infant formula industries. 31 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Cooking Demonstration on Diet for Mothers and Infants Cooking demonstrations are implemented in health clinics since the establishment of the maternal and child health services. The main objective of this activity is to educate mothers on ways to prepare balanced diet for pregnant and lactating mothers and infants and young children. These include preparation of complementary food which should be introduced when the baby is six months old in addition to breast milk. Supplementary Feeding Programme for Pregnant and Lactating Mothers Supplementary Feeding Programme for Pregnant and Lactating Mothers (Full Cream Milk Programme) has been implemented since 1970s. The objective of the programme is to improve the nutritional intake of mothers. This helps to overcome nutritional problems such as poor weight gain and anaemia among pregnant mothers. In addition, pregnant mothers are given haematinics to increase their iron level. Haematinics are also being given to lactating mothers who are anaemic. The Supplementary Feeding Programme Guideline developed in 2008 is being reviewed to strengthen its implementation. Anaemia Prevention Programme Anaemia Prevention Programme was started as early as 1980s to improve nutritional status among pregnant and postnatal mothers. All pregnant and postnatal mothers are given haematinic which consists of iron (ferrous fumarate), folic acid, vitamin C and B12 (cobalamin) for both preventive and curative measures. This helps to improve pregnancy outcome such as infant’s birth weight. Status of anaemia amongst antenatal mothers attending government health clinics are monitored based on their haemoglobin level at 36 weeks gestation period. Health education and nutrition counselling are also given to encourage the mothers to consume foods high in iron and to increase vitamin C intake in their daily diet. Iodine Deficiency Disorders (IDD) Programme This programme has been implemented since 1996 with the objective to virtually eradicate IDD in Malaysia. Activities include distribution of iodised salt to pregnant mothers in endemic areas and nutrition education on how to increase iodine intake. Universal Salt Iodisation (USI) has been implemented in Sabah since 1999 and in Sarawak in 2008. The USI for the whole of Malaysia is expected to be gazetted in 2017 to ensure sufficient iodine intake amongst the population. 32 National Plan of Action for Nutrition of Malaysia III, 2016-2025 33 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Nutrition Surveillance The objective of nutrition surveillance for children under 5 years is to monitor their nutritional status. The parameters that are monitored are weight-for-age, weight-for height, height-for-age and BMI-for-age. Data from this system provides information to be used in policy development and programme planning and implementation. Rehabilitation Programme for Malnourished Children (Program Pemulihan Kanak-Kanak Kekurangan Zat Makanan, PPKZM) The Rehabilitation Programme for Malnourished Children (PPKZM) has been implemented since 1989 as an effort to improve the nutritional status of children aged six months to six years from hard core poor families. Children who meet the criteria are given basic food supply to ensure food and nutrition security in order for them to achieve normal growth and physical development. The children are also given immunisation and treatment. Health education focusing on child nutrition and personal hygiene are emphasised to parents. As an extension to the PPKZM, the Community Feeding Programme is implemented to specifically rehabilitate undernourished children from the marginalised groups which are the Orang Asli and the Pribumi of Sarawak. This programme was identified under the Government Transformation Programme (GTP 2.0) National Key Result Area Low Income Household for the year 2013-2015. This programme has been implemented in the remote areas in Perak, Pahang, Kelantan and Sarawak. The target coverage of >95% was achieved in 2014. 5.3 Nutrition Programmes and Activities for Children 6 Years and Below Healthy eating promotion activities are conducted in childcare centres nationwide. Nutritionists are involved in the development of menus and recipes for government childcare centres. Caregivers are trained to carry out the monitoring of nutritional status of the children and the preparation of healthy and safe meals in the childcare centres. Various nutrition inputs are provided to support nutrition activities conducted by other agencies, such as Community Development Department (KEMAS), Institutes for National Integration Studies and Training (IKLIN) and the Association of Registered Childcare Providers (Persatuan Pengasuh Berdaftar Malaysia, PPBM). 5.4 Nutrition Programmes and Activities for Children with Special Needs The nutrition programme for children with special needs is implemented in health clinics and Community Rehabilitation Centres (Pusat Pemulihan Dalam Komuniti, PDK). Nutrition components are incorporated into existing activities through the implementation of guidelines and manuals for the implementation of My Healthy PDK (PKD Ku Sihat). Among the activities carried out are monitoring of nutritional status of children with special needs, nutrition education and training on healthy catering for caregivers. 5.5 Nutrition Programmes and Activities for School Children Nutrition plays an important role in the growing and development of children and adolescents to sustain good health. In achieving and maintaining the nutritional well-being of these groups, several activities are implemented targeted at preschoolers, school children and adolescents. 34 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Nutrition Activities at Childcare Centres (TASKA) 35 National Plan of Action for Nutrition of Malaysia III, 2016-2025 The Ministry of Health Malaysia works closely with the Social Welfare Department under the Ministry of Women, Family and Community Development, the Community Development Department (KEMAS) under the Ministry of Rural and Regional Development and the Ministry of Education in implementing nutrition programmes targeted at child care centres and preschools. The activities include providing technical guidance on nutrition-related activities such as menu reviewing, healthy and safe meal preparation, nutrition education and nutritional status monitoring. Nutrition programmes and activities have been conducted in schools since the 1970s. The activities include the School Feeding Programme (Rancangan Makanan Tambahan, RMT), School Milk Programme (Program Susu 1Malaysia), nutrition integration into the school curriculum, monitoring foods sold in school canteens in consistence with the School Canteen Management Guidelines, menu development for boarding schools and nutrition education targeted at school children, teachers, school canteen operators and parents. In addition, healthy catering training is conducted for school canteen operators to improve their knowledge and skill in preparing healthy meals at school canteens. The sale of unhealthy foods outside the school perimeters is prohibited as outlined in the Guidelines on the Prohibition of Sales of Foods Outside School Perimeters (Garis Panduan Penguatkuasaan Larangan Penjualan Makanan dan Minuman di Luar Pagar Sekolah) which is enforced by the Local Authorities. Furthermore, nutritional status of the school children are monitored routinely and the information are recorded in the Student Health Record (Rekod Kesihatan Murid, RKM). The nutritional status of the students are also monitored through the SEGAK (Ujian Standard Kecergasan Fizikal Kebangsaan) programme which is implemented to assess the student fitness level. Preschoolers (5-6 years) Primary/ Secondary (7 - 17 years) 5.6 Nutrition Programmes and Activities for Adolescents 5.7 Nutrition Programmes and Activities for Adults 36 National Plan of Action for Nutrition of Malaysia III, 2016-2025 As an extension of nutrition activities in schools, nutrition activities such as monitoring of nutritional status and provision of healthy menus are conducted at the National Service Training Programme (Program Latihan Khidmat Negara, PLKN) targeted for school-leavers. Activities on nutrition promotions are also conducted for youths at higher education institution through PROSIS (Program Siswa Sihat) programme. Recently, nutrition promotion activities are conducted annually during the National Youth Day (Hari Belia Negara). Healthy Cafeteria Healthy Cafeteria aims to provide nutritious and safe foods to consumers. It is implemented based on the Guidelines for the Assessment of Healthy Cafeteria Recognition. This initiative aims to provide a supportive environment for healthy eating practices. Until 2015, there have been 104 cafeterias have been recognised as Healthy Cafeterias. 37 National Plan of Action for Nutrition of Malaysia III, 2016-2025 The objective of Healthy Catering Training is to increase knowledge and skill on the preparation of safe and healthy foods. This training is targeted at various sectors including schools, work places and institutions. The module includes introduction to healthy eating, how to prepare healthy foods, recipe modifications and food safety. The training was first implemented in 2004. Every district conducts this training at least once a year. From 2004 to 2015, a total of 841 trainings have been conducted covering 49,479 food operators. Healthy Catering Training Healthy Meal Provision during Meetings focuses on the provision of health menu meal options, calorie tagging and instilling healthy eating practices such as provision of low fat milk, separation of sugar from hot drinks, providing plain water and serving of fruits and vegetables. This activity was first implemented in the Ministry of Health in 2011 and was expanded to other ministries in 2012. Healthy Meal Provision during Meetings (Penyediaan Hidangan Sihat Semasa Mesyuarat, PHSSM) Healthy Eating through Healthy Shopping is another approach for nutrition education and promotion using interactive methods. The main activity in this initiative is the Supermarket Tour whereby customers are guided for a tour and taught how to read labels and select healthier food options for the various food groups which are cereals; fruits and vegetables; fish, meat and poultry; milk and milk products and oil. From 2012 until 2015, a total of 914 activities have been carried out nationwide involving 30 hypermarkets throughout the country. Healthy Eating Through Healthy Shopping Healthy Community Kitchen is aimed to enhance the nutritional status of families and communities through active participation of the community. This includes smart partnership concept between intra and inter agencies to conduct various activities according to the needs and requests from the target groups. Cooking demonstrations, development of healthy recipes, gardening and relevant talks and trainings are amongst the activities conducted to encourage the community to practise healthy eating. Until 2015, there are a total of 57 DSM throughout the country. Healthy Community Kitchen (Dapur Sihat Masyarakat, DSM) 5.8 Nutrition Programmes and Activities for Elderly Nutrition is one of the important factors in maintaining the well-being of the elderly. Therefore, educational materials targeted to this group such as leaflets on Nutrition Guide for the Elderly are developed and distributed. Malaysian Dietary Guidelines for the Elderly is currently being developed to ensure standard messages on nutrition are disseminated to this target group. To increase the nutrition knowledge and skill of care takers of the elderly, nutrition training module for elderly in institutions have been developed. This module is used by health staff and social workers. 5.9 Other Nutrition Programmes and Activities Nutrition Education Other than nutrition education, activities to promote healthy eating are also being conducted in various forms such as dietary counselling, cooking demonstrations and exhibitions. These activities are carried out either individually or in groups. Prime and supportive messages to promote good nutrition to the public have been developed and disseminated through publication of educational materials and articles. Messages are also disseminated through television and 38 National Plan of Action for Nutrition of Malaysia III, 2016-2025 39 National Plan of Action for Nutrition of Malaysia III, 2016-2025 cinema trailers and crawlers, talks on TV and radio to reach of both urban and rural population. Nutrition messages are also blasted through social media such as Facebook, Twitter and YouTube. In early 2015, smartphone application, namely MyNutriApps II: MyNutriDiari, was introduced to the public to create a calorie conscious society and regular body weight monitoring especially among adults. Nutrition Information Centre (NIC) Nutrition Information Centre was established in 2007 to disseminate nutrition information to the public. There are a total of 15 NICs throughout the country. Nutrition Counselling Services Counselling services are conducted in health clinics to assist individuals or small groups on dietary management, appropriate diets and healthy lifestyles. The main target groups are parents or carers of malnourished children, anaemic pregnant women, overweight and obese adults and people with diabetes, hypertension and hyperlipidaemia. This service was first implemented in 2007 and expanded to cover 150,000 clients in 2015. Inter-Sectoral Collaboration with Non-Government Organizations Non-government organisations, professional bodies and the food industry play vital roles in promoting and supporting nutrition programmes and activities. Therefore, the Ministry of Health Malaysia works very closely with them in disseminating nutrition information, development of nutritional guidelines and providing supporting environment that promotes healthy lifestyle. Nutrition Month Malaysia (NMM) Nutrition Month Malaysia observed annually in April, is an initiative of the Nutrition Society of Malaysia (NSM), Malaysian Dietitians Association (MDA) and Malaysian Association for the Study of Obesity (MASO) supported by MOH to promote healthy eating and active living. Various nutrition related activities are conducted during NMM at both national and state levels. 40 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Nutrition Information on Food Labels to Assist in Food Choice Two main types of nutrition information on the label of pre-packaged foods have been made available by the enforcement of regulations on nutrition labelling and claims since 2005. Nutrition labelling or nutrient declaration enables the consumer to know the content of various nutrients in the pre-packaged foods. Nutrition claims provide further information to the consumers regarding the nutrients in the products, including their functions. These nutrition information are useful in guiding consumers choose the appropriate pre-packaged foods. Implementation of Front-of-Pack (FOP) Labelling As an extension to nutrition labelling, Front-of Pack Labelling is implemented to serve as a quick guide for consumers on calorie and nutritional content of food products and helps them choose healthier food options. One of the examples is FOP for energy which has been implemented in Malaysia since 2013. FOP for energy assists consumers in planning their daily energy intake. Other initiatives of FOP for Healthier Choice Logo is being developed by the MOH, other related government bodies, industries, academicians and professional bodies. Healthy Eating Initiative in Fast Food Restaurants In view of the mushrooming of fast food restaurants in Malaysia, an initiative has been taken by the Ministry of Health Malaysia and the fast food restaurants to provide healthier food options to the public. This is implemented through the Guideline on the Advertising and Nutrition Information Labelling of Fast Foods. Through this guideline, fast food advertisements and any sponsorship during children programmes on television are banned. Besides that, fast food outlets are required to provide nutrition information of their products. As outcomes of continuous dialogues with fast food industries, various efforts has been taken to reformulate fast food products including reducing content of salt, sugar and fat and increasing fibre content. Nutrition Related Programmes of Other Agencies Members of the Technical Working Group on Nutrition Promotion of the NCCFN have implemented numerous food and nutrition intervention programmes. The Nutrition Society of Malaysia (NSM) has conducted programmes targeted at specific groups, especially mothers, infants and children. Several recent programmes include the Mi-Care, Mother’s Smart Choice, MyNutriBaby, Positive Parenting, Healthy Kids and UniChef. NSM has also published three series of healthy recipe books to guide the public in preparing healthier meals. Federal Agriculture Marketing Authority (FAMA) has been actively promoting fruits and vegetables through the increasing number of Pasar Tani (Farmers Market) which sell local fruits and vegetables, KEMAS with Kebun Dapur Project at kindergartens. Other agencies include the Federation of Malaysian Manufacturers, Nutrition Society of Malaysia, Malaysian Health Promotion Board (MySihat), Consumer Association of Penang, Malaysian Association for the Study of Obesity, SME Corporation Malaysia, National Sport Council of Malaysia, Ministry of Communication and Multimedia, Ministry of Youth and Sport, Ministry of Domestic Trade, Co-operative and Consumerism. 41 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Achievements and Challenges of the NPANM II, 2006-2015 6.0 42 National Plan of Action for Nutrition of Malaysia III, 2016-2025 NPANM I, 1996-2000 National Nutrition Policy, 2005 S ince the 1970s, more intensified multi sectoral efforts were undertaken to improve the nutritional status of the Malaysian population, especially through the implementation of the Applied Food and Nutrition Programme (AFNP). From the late 1990s, nutrition intervention programmes were more systematically planned and implemented with the formulation of the first National Plan of Action for Nutrition of Malaysia (NPANM) I, 1996 2000. The first NPANM was prepared following the first International Conference on Nutrition (ICN), jointly organised by the Food and Agriculture Organization (FAO) and World Health Organization (WHO) in 1992. Formulated as a collaborative effort of various government 6.1 Background 43 National Plan of Action for Nutrition of Malaysia III, 2016-2025 NPANM II, 2006-2015 NPANM III, 2016-2025 agencies, academia, professional bodies and the food industry, NPANM I, 1996-2000 described in detail strategies and activities to combat both under and over nutrition problems, to be undertaken by all relevant stakeholders. Recognising the importance for effective inter governmental collaboration, a National Nutrition Policy was formulated in 2003 as recommended in NPANM I, 1996-2000. Taking into account the current and emerging nutrition issues in the country, National Plan for Action for Nutrition was reviewed and NPANM II, 2006-2015 was developed in tandem with the objectives and strategies of the National Nutrition Policy of Malaysia. To meet the objectives of NPANM II, 2006-2015, the following indicators and targets have been set to be achieved by the year of 2015. A number of interventions and activities were recommended for implementation to achieve the targets. During the mid-term review of NPANM II, 2006-2015 it was decided that the targets set for the indicators for preventing and controlling diet related non-communicable diseases do not have to be measured because the targets set for the three indicators, namely cardiovascular disease, cancer and osteoporosis are already covered under the indicators on food intake and dietary practices. Towards the end of NPANM II, 2006-2015, the achievements for the targets for each indicator were measured, as presented in the following tables. Indicators Target to be achieved by 2015 Achievement 1. Percentage of new born babies Increase from 86.4% initiate breastfeeding by placing 63.9% to 75.0% babies on skin to skin contact with (Source: BHFI Assessment, MOH 2013-2015-unpublished data) their mothers immediately following birth for at least one hour. 2. Prevalence of exclusive Increase from 63.1% breastfeeding for 4 months. 19.3% to 40.0% (Source: Health Informatics Centre, MOH 2015) 3. Prevalence of exclusive Increase from 49.4% breastfeeding for six months. 14.5% to 35.0% (Source: Health Informatics Centre, MOH 2015) 4. Prevalence of timely introduction to 75.0% 92.2% complementary foods. (Source: Health Informatics Centre, MOH 2015) 5. Percentage of babies who received 75.0% Data not available food from 4 or more food groups. Note: 6. Percentage of babies who received 75.0% This data will be available after 2016 through solid, semi solid or soft foods National Health and Mobidity Survey (NHMS) which will according to minimum be conducted on four yearly basis. recommendation of Guidelines for the Feeding of Infants and Young Children 2008. 44 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Table 1: Improving Breastfeeding and Complementary Feeding Practices 6.2 Achievements of NPANM II, 2006-2015 45 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1. Percent of adults meeting the RNI, Increase of The intake of almost all nutrients did not achieve the 2005. 10% of adults targets except for iron. However, these data need to be • Meeting 75-100% of meeting the treated with caution as studies have pointed out that RNI for energy. RNI compared there could be high percentage of under reporting • Meeting ±25% of to Malaysia during dietary recall, limitation in food composition RNI for other Adults database, human error during data management and nutrients. Nutrition analysis. Survey 2003 findings. Indicator Target to be achieved by 2015 Achievement Nutrients Categories Baseline % (MANS 2003) Achievement % (MANS 2014) Target to be achieved in 2015 At least 28.2% Calories Meeting 75% to 100% of RNI for energy 25.6 meeting the 23.0 recommendation for calories At least 49.5% Protein Meeting 75% to 125% of RNI for energy 45.0 meeting the 42.3 recommendation for protein At least 18.2% Vitamin C Meeting 75% to 125% of RNI for energy 16.5 meeting the 17.8 recommendation for vitamin C At least 15.3% Calcium Meeting 75% to 125% of RNI for energy 13.9 meeting the 13.2 recommendation for calcium At least 19.3% Iron Meeting 75% to 125% of RNI for energy 17.5 meeting the 26.1 recommendation for iron At least 26.2% Vitamin A Meeting 75% to 125% of RNI for energy 23.8 meeting the 22.7 recommendation for vitamin A At least 25.0% Thiamine Meeting 75% to 125% of RNI for energy 22.8 meeting the 19.2 recommendation for thiamine Table 2: Improving Food Intake and Dietary Practices MANS 2014 reported that more than half of the population are below the RNI for energy, calcium, thiamine and vitamin C. Slightly less than half of the population were below the RNI for iron and vitamin A. For energy contribution, percent of adults meeting macronutrient contribution to total energy intake according to RNI are also below the target. About half of the adults were found to have exceeded the recommended protein contribution to total energy intake (50.7%) and fat contribution intake to total energy intake (45.6%) according to RNI. 46 National Plan of Action for Nutrition of Malaysia III, 2016-2025 2. Percent of adults meeting At least For all three macronutrients, more than half of macronutrient contribution to total 75% of adults Malaysian adults not meeting the RNI recommendation energy intake according to RNI. meeting for the contribution to total energy intake. Almost • Carbohydrate (55-70%) macronutrient half (45.6%) were found to have exceeded the • Fat (20-30%) contribution recommended fat contribution to total energy intake • Protein (10-15%) to total energy according to RNI. Whilst, half (50.7%) of the adults intake were found to have exceeded the protein contribution according to total energy intake according to RNI. to RNI. Indicator Target to be achieved by 2015 Achievement Carbohydrate Macronutrient Contribution to total energy intake Achievement % (MANS 2014) 55 to 70% 40.2 20 to 30% 40.8 10 to 15% 40.4 Fat Protein Table 2: Improving Food Intake and Dietary Practices 47 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Indicator Target to be achieved by 2015 Achievement Table 2: Improving Food Intake and Dietary Practices 3. Percent of adults meeting Increase of Based on the comparison between reanalysed data recommended servings for 10% of adults from MANS 2003 and MANS 2014, it showed that different food groups in the meeting some food groups such as " meat, poultry and egg", Malaysian Food Pyramid. recommended "fish & fish products", "legumes & nuts" and "milk and servings for dairy products" achieved the target. However, the different food percentage not meeting the recommended servings for groups "legumes and nuts" (81.9%) and "milk and dairy compared to products" (73.6%) in MANS 2014 were still high. Malaysia Whereas, the other food groups were below the target Adults including fruits and vegetables. Nutrition Survey 2003 findings. Food groups Servings per day Baseline % (MANS 2003) Achievement % (MANS 2014) Target to be achieved in 2015 Cereal and cereal At least 58.0% meeting the recommendation products and 4 to 8* 52.9 for cereal and cereal products and tubers 41.3 tubers At least 18.7% meeting theFruits 2* 17.0 recommendation for fruits 14.9 At least 15.3% meeting theVegetables 3* 13.9 recommendation for vegetables 7.9 Meat, poultry At least 57.6% meeting the & egg 1/2 to 2* 52.4 recommendation meat, poultry & egg 66.8 Fish & fish At least 22.6% meeting the products 1* 20.6 recommendation for fish & fish products 31.3 At least 13.5% meeting theLegumes & nuts 1/2 to 1* 12.3 recommendation for legumes & nuts 17.1 Milk & dairy At least 24.1% meeting the products 1 to 3* 21.9 recommendation for milk & dairy products 24.4 *Recommended servings in the Malaysian Food Pyramid. 48 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1. Low birth weight (<2.5kg) Reduce from 11.3% 10.6% to 6.0% (Source: DOS 2013) 2. Children below 5 years: Underweight (Weight for age < 2SD) Reduce from 12.4% 12.9% to 6.5% Stunting (Height for age < -2SD Reduce from 17.7% 17.2% to 9.0% Wasting (Weight for height < -2SD) Reduce from 8.0% 14.9% to 7.0% (Source: NHMS 2006)* (Source: NHMS 2015)* 3. Children aged 7 years: Reduce from 9.4% 11.2% to 6.0% Thinness (BMI for age < -2SD) (Source: NHMS 2006)** (Source: NHMS 2015)** 4. Children aged 12 years: Reduce from 8.8% 8.6% to 5.0% Thinness (BMI for age < -2SD) (Source: NHMS 2006)** (Source: NHMS 2015)** 5. Children aged 15 years: Reduce from 6.4% 10.1% to 5.0% Underweight (BMI for age < -2SD) (Source: NHMS 2006)** (Source: NHMS 2015)** 6. Adults aged 18-59 years: Reduce from 6.9% 8.1% to 4.0% Underweight (BMI <18.5 kg/m2) (Source: NHMS 2006)*** (Source: NHMS 2015)*** 7. Elderly aged 60 years and above: Reduce from 5.8% 11.0% to 5.0% Underweight (BMI <18.5 kg/m2) (Source: NHMS 2006)*** (Source: NHMS 2015)*** Indicator Target to be achieved by 2015 Achievement Table 3: Reducing Protein-Energy Malnutrition *WHO 2006 **WHO 2007 ***WHO 1998 49 National Plan of Action for Nutrition of Malaysia III, 2016-2025 All the targets identified for the 7 indicators to reduce protein-energy mulnutrition were not achieved. These indicators covered almost the entire lifespan, from birth, below five years, school aged children, adult until elderly. Low birth weight prevalence was found to be almost double the target set. There could be several possible reasons for this, such as improvement in medical care and technology so that more premature babies survived and thereby contributing to the higher prevalence of low birth weight. To have a more accurate picture of the prevalence of low birth weight, it is suggested that the Statistics Department presents the prevalence of low birth weight for term babies separately from those who were born preterm. Nevertheless, the high prevalence of low birth weight should not be ignored and further emphasis need to be given to improve maternal nutrition. All the three indicators for undernutrition for children below five years were found to have exceeded the targets set. The problem of stunting was particularly serious as the prevalence was found to have increased compared to the baseline. There was also no improvement in the prevalence of underweight. Serious attention needs to be given immediately to promoting children nutrition. Effective strategies need to be planned and implemented to reach the population in all parts of the countries to prevent and control undernutrition problem. It was also found that the prevalence of undernutrition among school aged children (7, 12 and 15 years) did not meet the targets and remain at the same order of magnitude compared to a decade ago. Promoting healthy eating among school children should be given urgent attention. Activities on nutrition education and intervention should be rolled out to all schools in the countries. Greater emphasis should be given to the systematic and proper implementation of the monitoring of the BMI of school children. The identified malnourished children should be referred to the nutritionist for nutrition counselling. For adults and elderly undernutrition indicators, the current prevalence were higher than the set target. This is probably because the targets were set too low and unrealistic during the mid-term review of NPANM II in 2010. Before the mid-term review, the original target set for adult was 15%, and that for the elderly was 20% by 2015. If these targets were retained, the current prevalence would have been below these values. It could be that the prevalence of undernutrition among adults and elderly at the current level has reached a plateau. It may be rather difficult to further reduce the prevalence lower to the set target of about 5%. Furthermore, it could be ambitious to attempt to lower the prevalence of under nutrition among adults by half within a short period of five years. 50 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1. Anaemia: Reduce from SEANUTS 2013 study reported the prevalence of 18.0% to 9.0% anaemia among 4 to 7 years were 11.3% for urban and Children below 5 years 17.6% for rural. It would appear that the projected (Hb <11g%). (Source: target may not be met. WHO/ UNICEF 2000) 2. Anaemia: Not more SEANUTS 2013 study reported the prevalence of than 20.0% anaemia among girls aged 7 to 12 years were 3.5% Female teenagers for urban and 1.9% for rural. It would appear that (Hb <12g%). the projected target may not be met. 3. Anaemia: Reduce from 8.2% 22.0% to 16.0% Pregnant women (Source: Health Informatic Centre, MOH 2015) (Hb <11g%). (Source: Health Informatics Centre, MOH 2009) 4. Vitamin A deficiency: Not more SEANUTS 2013 study reported the prevalence of Children below 5 years than 20.0% vitamin A deficiency (<0.7µmol/L or <20µg/dl) among 4 (Serum retinol <20µg/dl). to 7 years were 6.6% for urban and 10.9% for rural. It would appear that the projected target may not be met. 5. Iodine deficiency: Median urinary Surveillance report from Sabah (2015) indicated a Median urinary iodine iodine excretion median urinary iodine excretion level of 158 µg/L. excretion level among level between children aged 8 to 10 100 µg/L and years. 200 µg/L Percentage of school Reduce from Surveillance report from Sabah (2015) indicated that children aged 8 - 10 years 48.0% to <40.0% 29.1% of school children aged 8 -10 years had median with median urinary urinary iodine < 100 µg/L. iodine < 100 µg/L. (Source: National IDD Survey 2009) 6. Iodine deficiency: Median urinary Surveillance report from selected areas from Sabah Median urinary iodine iodine excretion (Pitas, Kota Belud and Kinabatangan), 2010 indicated excretion level among level between that the median urinary iodine excretion level of pregnant women in the 150 µg/L and pregnant women in the first trimester was 265.3 µg/L. first trimester. 249 µg/L Indicator Target to be achieved by 2015 Achievement Table 4: Reducing Micronutrient Deficiencies Currently, most identified indicators in reducing micronutrient deficiencies did not have a mechanism for data collection. However, routine monitoring of median urinary iodine excretion level will be carried out after gazzettment of USI for Malaysia to be expected in 2018. It is noted that the prevalence of vitamin A deficiency still exists that among the rural children below 5 years. 51 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1. Prevalence of overweight among Reduce from 9.3% children aged 7 years. 8.0% to 6.0% (Source: NHMS 2015)* (Source: NHMS 2006)* Prevalence of obesity among Reduce from 14.0% children aged 7 years. 8.3% to 6.0% (Source: NHMS 2015)* (Source: NHMS 2006)* 2. Prevalence of overweight among Reduce from 17.8% children aged 12 years. 15.9% to 13.0% (Source: NHMS 2015)* (Source: NHMS 2006)* Prevalence of obesity among Reduce from 16.8% children aged 12 years. 12.0% to 10.0% (Source: NHMS 2015)* (Source: NHMS 2006)* 3. Prevalence of overweight among Reduce from 16.0% children aged 15 years. 12.4% to 10.0% (Source: NHMS 2015)* (Source: NHMS 2006)* Prevalence of obesity among Reduce from 8.4% children aged 15 years. 7.7% to 5.0% (Source: NHMS 2015)* (Source: NHMS 2006)* 4. Prevelance of overweight among Not more 30.0% adults aged >18 years. than 35.0% (Source: NHMS 2015)** Overweight (BMI: 25.0-29.9 kg/m2) Baseline: 29.1% (Source: NHMS 2006)** Prevelance of obese among Not more 17.7% adults aged >18 years. than 20.8% (Source: NHMS 2015)** Obese (BMI: > 30 kg/m2) Baseline: 14.1% (Source: NHMS 2006)** Indicator Target to be achieved by 2015 Achievement Table 5: Reducing Overweight and Obesity *WHO 2007 **WHO 1998 52 National Plan of Action for Nutrition of Malaysia III, 2016-2025 The severity of overweight and obesity among school-aged children has worsened as compared to a decade ago. The prevalence of overweight and obesity among school aged children aged 7, 12 and 15 years exceeded the set targets.. It is imperative that prevention of over-nutrition among school children should be given serious attention. Periodic monitoring of BMI should be properly conducted and the overweight and obese children referred to the nutritionist for nutrition counselling together with their parents. The only way for these activities to be effectively implemented is to assign nutritionists to be in schools. In addition, school authorities should be informed and fully supportive and participatory in all these activities. The prevalence of overweight and obesity amongst adults met the targets. For overweight, there was no increase compared to the baseline in 2006. However, the combined prevalence of overweight and obesity at 48% is considered high. There should be no let-up in the implementation of activities to further reduce the prevalence of over-nutrition in the country. W E C A N ‘T 53 National Plan of Action for Nutrition of Malaysia III, 2016-2025 6.3 Challenges of NPANM II, 2006-2015 Some activities identified in the NPANM II (2006-2015) were not implemented. Below are some of these activities. The establishment of the National Institute of Nutrition (NIN) was put on hold because the Ministry of Health was focusing on the establishment and development of Nutrition Division at the headquarters level. The Nutrition Division was established in October 2009 after 15 years being a section under the Family Health and Development Division. However, recognising the importance of National Institute of Nutrition (NIN) as a centre for nutrition research and training, this agenda will be carried forward for implementation in the NPANM III, 2016-2025. The proposal to employ nutritionists at various ministries was not taken up. Providing sufficient number of nutritionist for population is a big challenge. In fact, there is still a shortage of nutritionist at government health sector. According to WHO, there must at least 10 allied health professionals for every 100,000 population. Currently, there is only about three nutritionists and dietitians for every 100,000 population. Therefore, it is crucial to ensure sufficient number of nutritionists at the community to intensify the nutrition promotion and interventions at all levels. More outreach activities need to be carried out especially targeting at the vulnerable groups such as infants and young children. Greater attention needs to be given to nutrition promotion and intervention in schools considering the increasing trend of obesity amongst school children and the existence of under nutrition. An effective referral system from school to health clinic is needed to manage children who are underweight, obese and overweight. It is also recommended that nutrition education to school children are given based on tested educational modules. As part of school-based activities, monitoring of school canteens needs to be further strengthened. Currently, activities to prevent and control protein-energy malnutrition only focuses on children attending the government clinics and indigenous groups namely Orang Asli and Penan. Realising that the stunting and wasting prevalence among children under five years are increasing, more outreach activities to address these need to be identified. In the NPANM II, the implementation of Baby Friendly Hospital Initiative (BFHI) was unfavourably taken up by the private hospitals. Until October 2016, there were only 15 private hospitals that had received the BFHI recognition. There is a need to carry out more intensive advocacy activities at state level to further increase the number of private hospitals with BFHI recognition. In addition to further promote exclusive breastfeeding practices in Malaysia, the proposal for the extension of maternity leave which is consistent with International Labour Organisation (ILO) Maternity Convention and recommendations will be further pursued in the NPANM III, 2016-2025. Findings of national surveys showed that most of the Malaysians are still not able to fully understand and translate the concept of the Food Pyramid into practices. Massive promotion of the Malaysian Dietary Guidelines (MDG) and dissemination of the related educational materials need to be carried out. The use of social and mass media as a communication medium to promote healthy eating messages to the public must be optimised. It is important to reach out the food operators/ providers to encourage them to 54 National Plan of Action for Nutrition of Malaysia III, 2016-2025 provide healthier meals in support of the changing Malaysian food preference. Periodic engagement with food and beverage industries to reduce the level of calories, fat, salt/ sodium and sugar in processed/prepackaged foods as well as ready-to-eat meals need to be carried out. At the same time, it is crucial to further strengthen public awareness programmes on healthy eating. Specific challenges 1. Lack of intersectoral and multi-stakeholder coordination Intersectoral coordination is essential at all stages of the process, from the preparation of the NPANM framework, implementation and monitoring and evaluation of the activities and impact indicators. Despite periodic meetings of the National Coordinating Committee on Food and Nutrition (NCCFN), the multi-sectoral commitments in nutrition still need to be strengthened. Nevertheless, governmental coordination is also fundamental between national and subnational levels. Strong political commitment is required to ensure the collaboration from various sectors. This will facilitate the implementation of this plan. The population is often not involved or aware on decision-making processes. Therefore, there is a need to develop a road map that allow adequate coordination between national and subnational levels, with involvement of other related stakeholders and community representatives to ensure commitment and active participation. 2. Financial shortfall and lack of sustainable financial commitment To ensure the improvement of nutritional status of the population, improvement in budget allocation to tackle malnutrition is crucial. Insufficient political commitment to tackling malnutrition has led to a financial shortfall. Based on the Global Nutrition Report (GNR) 2015, it is estimated of the percentage of global government allocation to nutrition range from 0.06% of total government budget to 2.90%. An adequate, and predictable funding is key to ensure the effective delivery of nutrition programmes and activities in the the country. 3. Lack of capacity Human resource capacity to deliver nutrition programmes and activities is crucial. Technical expertise should be in place at all levels, which not only depending with nutritionist in the health sectors. The employment of nutritionist in critical ministries dealing with food, children and community is a great strategies to ensure nutritional wellbeing of the Malaysian. This human resource capacity is needed to coordinate, implement, monitor and evaluate the programmes and activities related with nutrition at all level. 4. Lack of monitoring and evaluation The data needs to be more effectively used to analyze bottlenecks and gaps, which can then be addressed to improve programme performance. Therefore, nutrition indicators need to be integrated in relevant frameworks at all levels. However, data is often not collected in a timely or in periodic, with large surveys such as the National Health and Morbidity Survey and the Malaysian Adults Nutrition Survey which carried out only every few years. Moreover, collected data can be of poor quality and often does not represent by state. 55 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Moving Forward in the NPANM III, 2016-2025 7.0 Goal Objectives Strategies 7.0 MOVING FORWARD IN THE NPANM III, 2016-2025 In line with the Declaration of International Conference in Nutrition 2014 and Framework of Action as well as global, regional and national level development and direction on nutrition, NPANM II, 2006-2015 has been reviewed and NPANM III, 2016-2025 for the next decade has been formulated. Food and nutrition security is the new focus area in the NPANM III for the next 10 years. Thus, four pillars of food and nutrition security which are availability, accessibility, affordability and utilisation of food will be addressed in the Plan. To ensure effective implementation, monitoring and evaluation of the Plan, these strategies are outlined with the foundation, enabling and facilitating strategies based on the goal and objectives that have been set. 56 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1 2 Key Elements In NPANM III, 2016-2025 57 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Expansion and strenghthening of the existing foundation strategy incorporating nutrition objectives, consideration and components not only into national development policies but also into action Plans Greater emphasis in ensuring food and nutrition security In ensuring the commitment and participation of key stakeholders in the implementation of NPANM III, 2016-2025, all participating agencies are encouraged to integrate nutrition policy and programmes in their development plan and action plans. Some of the major national development policies and action plans that can be incorporated are the National Agro-food Policy, National Women Policy, Malaysian Education Blueprint, National Consumer Policy and National Social Welfare Policy. The progress of the nutrition policy and programmes incorporated in their respective development and action plans will also be continuously monitored and disseminated through the National Food Safety and Nutrition Council and the National Coordinating Committee on Food and Nutrition. The objective of NPANM III, 2016-2025 goes beyond improving household food security whereby the element of nutrition security is given greater emphasis in line with global directions and agenda, such as ICN2 Declaration & Framework for Action as well as Nutrition and the post-2015 Sustainable Development Goals (SDGs) in the next decade. Therefore, to effectively address the multiple challenges with regards to food and nutrition security to end all forms of malnutrition including eradicating hunger in the country particularly undernourishment, stunting, wasting, underweight and overweight in children under five years of age; and anaemia in women and children among other micronutrient deficiencies, a concerted effort through multi-sectoral approaches involving key agencies such as the Ministry of Agriculture and food industries is very crucial. Thus, to uplift households towards a middle class society, initiatives on the Rehabilitation Programme for Malnourished Children and Community Feeding Programmes will be continued and strengthened. 3 Incorporating two new enabling strategies which are toprevent and control obesity and other diet-related NCDs as well as to sustain food systems to promote healthy diets In response to an alarming trend of diet-related non-communicable diseases (NCDs) in the past two decades, there is an urgent need to halt or reduce the rising trends in overweight and obesity as well as other diet-related NCDs among Malaysian. Therefore, two additional enabling strategies have been incorporated in NPANM III, 2016-2025 which are to reduce obesity and diet related NCDs and and sustaining food systems for a healthy diet. Individual and community empowerment for the prevention and control of diet-related chronic diseases are given greater emphasis. Some of the main focus areas for promoting sustainable food systems through healthy diet incorporated in the 11th Malaysia Plan (2016 – 2020) are as follows: • Public – private partnership Collaboration with food and beverage industries to produce healthier food and beverage products. • Implementation of weight reduction programmes for school children. • Creating a healthy ecosystem which will contribute towards healthy lifestyle and disease prevention. Promotion activities on prevention of food wastage. • Incorporate nutrition to sustain food systems through collaboration with all relevant ministries and non-government agencies, such as: Establishment of ‘Nutrition Enhancing Agriculture Food Supply Calculator’. Engagement with food industries (food service operators and manufacturers) to come up with higher availability of healthier food options. Strengthening Kebun Dapur Projek initiated by KEMAS to inculcate fruit and vegetable consumption amongst young children. 58 National Plan of Action for Nutrition of Malaysia III, 2016-2025 4 5 Inclusion of maternal nutrition to the enabling strategy of promoting infant and young child nutrition Strenghthening the facilitating strategies in providing standard nutrition guidelines for various age groups and community capacity for nutrition Inclusion of promotion of maternal nutrition to the enabling strategies of infant and young child nutrition in line with Global Monitoring Framework for Maternal, Infant and Young Child Nutrition, especially in the following areas: • Strengthening the maternal nutrition strategies (e.g: anaemia/ IDD/ GDM/ appropriate weight gain among pregnant mothers). • Greater emphasis on nutrition during the first 1000 days of life (e.g: breastfeeding and complementary feeding). • Strengthening the Code of Ethics for the Marketing of Infant Foods and Related Products. The following facilitating strategies during NPANM II, 2006-2015 have also been reviewed and strengthened: • Standard nutrition guidelines for various age groups. To review the existing guidelines in line with global, regional and national targets and needs (RNI, MDG). • Institutional and community capacity building for nutrition. Accessibility of nutrition information and services by strengthening nutrition training and work force. • Nutrition research and development. Establishment of a National Institute of Nutrition (NIN) as a focal point for nutrition research and training. 59 National Plan of Action for Nutrition of Malaysia III, 2016-2025 School Children Pregnant Women Elderly Adults Adolescents Children 6 Years and Below Infants and Young Children 60 National Plan of Action for Nutrition of Malaysia III, 2016-2025 61 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Framework of the NPANM III, 2016-2025 8.0 Towards Achieving Optimal Nutritional Well-Being Of Malaysians Framework of NPANM III, 2016-2025 Providing standard nutrition guidelines for targeted groups NPANM III 2016-2025 To strengthen food and nutrition security To enhance nutritional status To reduce diet-related non-communicable diseases (NCDs) Promoting maternal, infant and young child nutrition Preventing and controlling obesity and other diet-related NCDs Promoting healthy eating and active living Sustaining food systems to promote healthy diets Preventing and controlling nutritional deficiencies Supporting efforts to promote food safety and quality Continuous assessment and monitoring of the nutrition situation Strengthening food and nutrition research and development Ensuring sufficient number of qualified nutritionists and dietitians Strengthening institutional and community capacity for nutrition Enabling Strategies Incorporating nutrition objectives, considerations and components into national development policies and action plans Facilitating Strategies Foundation Strategy Objectives Goal 62 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Goal Towards achieving optimal nutritional well-being of Malaysians Objectives Strategies Foundation Strategy Incorporating nutrition objectives, considerations and components into national development policies and action plans forms the overarching strategy and is vital for the effective implementation of the Plan. Enabling Strategies Six (6) strategies, identified as having direct impact on achieving the specific objectives of the Plan, serve as the enabling strategies. These are: • Promoting maternal, infant and young child nutrition • Promoting healthy eating and active living • Preventing and controlling nutritional deficiencies • Preventing and controlling obesity and other diet-related NCDs • Sustaining food systems to promote healthy diets • Supporting efforts to promote food safety and quality Facilitating Strategies Five (5) other strategies, identified as providing the mechanism and support for the realisation of the enabling strategies, form the facilitating strategy of the Plan. These are: • Providing standard nutrition guidelines for targeted groups • Continuous assessment and monitoring of the nutrition situation • Strengthening food and nutrition research and development • Ensuring sufficient number of qualified nutritionists and dietitians • Strengthening institutional and community capacity for nutrition 63 National Plan of Action for Nutrition of Malaysia III, 2016-2025 • To enhance nutritional status • To reduce diet-related non-communicable diseases (NCDs) • To strengthen food and nutrition security 64 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Foundation Strategy of NPANM III highlights the importance of incorporating nutrition objectives, considerations and components into national development policies and action plans in other relevant ministries and agencies. It forms the overarching strategy and vital for effective implementation. Enabling Strategies are identified as having direct impact on achieving the specific objectives of the plan. There are 6 sub enabling strategies as follows: Promoting Maternal, Infant and Young Child Nutrition This strategy focuses on activities involving maternal, infant and young child feeding. It has been highlighted to improve nutrition for mothers and children through various promotional and intervention activities. Promoting Healthy Eating and Active Living This strategy focuses on promotion to further increase awareness and practice of healthy eating which spans from toddlers to elderly. Various activities will be carried out in different settings and programmes such as child care centres, preschools, primary and secondary schools, National Service Training Programme (PLKN) camps, institute of higher learning and other institutions, as well as community. Preventing and Controlling Nutritional Deficiencies The activities under this strategy include an overall landscape analysis on malnutrition status among children to support in modifying existing nutrition strategies and programmes. Preventing and Controlling Obesity and Other Diet-related Non-Communicable Diseases (NCDs) The activities under this strategy emphasises on development of soft and hard policies that support and facilitate healthier behavioral change among population. It is to improve the prevalence of obesity and other diet-related NCDs. Sustaining Food Systems to Promote Healthy Diets This strategy supports the objectives of this Plan in strengthening food and nutrition security of the population. All activities outlined under this strategy contribute to sustainable food systems encompassing from farm to table. Supporting Efforts to Promote Food Safety and Quality Activities under this strategy include the education to create the awareness among population on food labelling, food safety and consumer rights. Mandatory declaration of total sugar, sodium and main fatty acids are proposed in this strategy as well. 65 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Facilitating Strategies are identified as providing the mechanism and support for the realisation of the enabling strategies. There are 5 sub facilitating strategies as follows: Providing Standard Nutrition Guidelines for Various Targeted Groups Activities under this strategy focuses on the development of nutrition guidelines suited with the dietary needs of the various age groups among Malaysian. It provides information on healthy eating to reduce risk of over nutrition and non-communicable diseases. Continuous Assessment and Monitoring of the Nutrition Situation The need for strengthening the national nutrition surveillance system for specific groups are highlighted in this strategy. The data from the surveillance system is important for the planning and implementation of intervention programmes. Strengthening Food and Nutrition Research and Development Research and development are important to provide evidence for development of policies and programmes. The establishment of Nutrition Research Priorities (NRP), update of Food Composition Database (FCD) and establishment of National Institute of Nutrition (NIN) are activities highlighted under this strategy. Ensuring Sufficient Number of Qualified Nutritionists and Dietitians This strategy focuses on activities that aim to ensure sufficient number of qualified professionals as well as their competencies. Strengthening Institutional and Community Capacity for Nutrition To ensure the effective implementation of intervention programmes, a mandatory nutritionist placement in relevant ministries and agencies as well as industries are given attention in this strategy. For further improvement in institutional and community capacity, nutrition-based training needs to be conducted to health care providers and professionals. 66 National Plan of Action for Nutrition of Malaysia III, 2016-2025 67 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Indicators of the NPANM III, 2016-2025 9.0 1 Promoting Maternal, Infant and Young Child Nutrition 2 Promoting Healthy Eating and Active Living 3 Preventing and Controlling Nutritional Deficiencies 4 Preventing and Controlling Obesity and Other Diet-related Non-Communicable Diseases (NCDs) 68 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1 Promoting Maternal, Infant and Young Child Nutrition 69 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1.1 Pregnant women 1.2 Neonates 1.3 Infants and young children No. Indicator Definition Baseline data Target for improvement by the year 2025 1.1 Pregnant Women 1.1 Percentage of Percentage of pregnant women 8.2% Not more than 5% (a) pregnant women with hemoglobin level less than (HIC, MOH 2015) with anaemia1 11g/dl Prevalence of anaemia (%) Classification ≥40 20.0-39.9 5.0-19.9 ≤4.9 (WHO 2006) Severe Moderate Mild Normal 1 Core indicators for the Global Nutrition Targets 2025 70 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 1.1 Percentage of Range of gestational weight gain 38% At least 50% of (b) pregnant women according to pre-pregnancy BMI (Audit Antenatal Card, MOH 2016- pregnant women with with unpublished data) recommended recommended gestational weight gain gestational weight gain at > 37 weeks of pregnancy 1.1 Percentage of Percentage of pregnant women 8.7% No increase from (c) pregnant women aged ≥ 25 years with fasting (National Obstetric Registry baseline with Gestational plasma glucose ≥ 5.6 mmol/l or Second Report 2010) Diabetes Mellitus 2HPP* ≥ 7.8 mmol/l (GDM) Time Venous Plasma Glucose Level Fasting <5.6 ≥5.6 2HPP <7.8 ≥7.8 (ADA, 2008) 2HPP*: 2 hour postprandial Normal GDM Pre-pregnancy BMI kg/m2 Recommended weight gain (kg) Underweight (< 18.5) Normal weight (18.5-24.9) Overweight (25.0 - 29.9) Obese (≥ 30.0) (IOM 2009) 12.5 - 18 11.5 - 16 7 - 11.5 5 - 9 71 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 1.2 Neonates Prevalence of low Weight of less than 2500g at 11.3% Not more than 8% birth weight1. birth. (DOS 2013) No. Indicator Definition Baseline data Target for improvement by the year 2025 1.3 Infants and Young Children 1.3 Prevalence of Children born who were put to the 65.3% 100% (a) early initiation of breast within one hour of birth (NHMS 2016) breastfeeding 1.3 Exclusive Proportion of infants 0-5.99 47.1% At least 70% (b) breastfeeding months of age who are fed (NHMS 2016) below 6 months exclusively with breast milk of age1 Percentage of infants 6 months + 49.4% At least 70% 1 week of age who are fed (SHD, MOH 2015) exclusively with breast milk 1.3 *Introduction to Proportion of infants 6-23 - To be determined (c) solids, semi-solids months of age who receive solids, based on NHMS or soft foods2 semi-solids or soft foods Percentage of infants at 6 months 92.2% At least 95% of age who receive solid, semi- (SHD, MOH 2015) solid or soft foods *Note: Initially this indicator is known as “Timely introduction to complementary food” 1 Core indicators for the Global Nutrition Targets 2025 2 Additional indicators for the Global Monitoring Framework on Maternal, Infant and Young Child (IO5) 72 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 1.3 Prevalence of Proportion of children 6-23 66.4% Not less than 90% (d) children receiving months of age receiving foods (NHMS 2016) minimum dietary from 4 or more food groups diversity2 1.3 Prevalence of Proportion of breastfed and non- 80.8% Not less than 90% (e) children receiving breastfed children 6-23 months (NHMS 2016) minimum meal of age receiving solids, semi frequency2 solids, or soft foods (but also including milk feeds for non breastfed children) Minimum is defined as: Breastfed children 2 times : 6-8 months 3 times : 9-23 months Non-breastfed children: 4 times: 6-23 months 1.3 Prevalence of Proportion of children 6-23 53.1% Not less than 90% (f) children receiving months of age receiving a (NHMS 2016) minimum minimum acceptable diet: acceptable diet2 Minimum is defined as: Breast-fed children: At least minimum dietary diversity and minimum meal frequency Non Breast-fed children: At least 2 milk feedings and at least minimum dietary diversity (not including milk feeds) and minimum meal frequency 2 Additional indicators for the Global Monitoring Framework on Maternal, Infant and Young Child (IO5) 2 Promoting Healthy Eating and Active Living 2.1 Malaysian Dietary Guidelines No. Indicator Definition Baseline data Target for improvement by the year 2025 2.1 Malaysian Dietary Guidelines 2.1 Percentage of Adults aged At least 60% of (a) adults meeting 18-59 years old adults meeting recommended recommended servings servings for Recommended for cereal and cereal cereal and cereal serving: products and tubers products and 4-8 servings/ day tubers 2.1 Percentage of Adults aged At least 25% of (b) adults meeting 18-59 years old adults meeting recommended recommended servings serving for Recommended for fruits fruits serving: 2 servings/ day 2.1 Percentage of Adults aged At least 15% of (c) adults meeting 18-59 years old adults meeting recommended recommended servings serving for Recommended for vegetables vegetables serving: 3 servings/ day Food group Servings per day % Meeting recommended servings Cereal and cereal products and tubers (MANS 2014) < 4 4 to 8 > 8 53.5 41.3 5.2 Food group Servings per day % Meeting recommended servings Fruits (MANS 2014) < 2 2 >2 59.1 14.9 26 73 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Food group Servings per day % Meeting recommended servings Vegetables (MANS 2014) < 3 3 > 3 81.7 7.9 11 74 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 2.1 Percentage of Adults aged At least 15% of (d) adults meeting 18-59 years old adults meeting recommended recommended serving serving for Recommended for fruits and fruits and serving: vegetables vegetables > 5 servings/ day 2.1 Percentage of Adults aged At least 75% of (e) adults meeting 18-59 years old adults meeting recommended recommended serving for serving for meat, Recommended meat, poultry and egg poultry and egg serving: 1/2-2 servings/ day 2.1 Percentage of Adults aged At least 50% of (f) adults meeting 18-59 years old adults meeting recommended recommended serving serving for Recommended for fish and fish fish and fish serving: products products 1 serving/ day 2.1 Percentage of Adults aged At least 50% of (g) adults meeting 18-59 years old adults meeting recommended recommended serving serving for Recommended for legumes and nuts legumes and serving: nuts 1/2 -1 serving/ day 2.1 Percentage Adults aged At least 60% of (h) meeting 18-59 years old adults meeting recommended recommended serving for serving for Recommended milk and dairy products milk and dairy serving: products 1-3 servings/ day 2.1 Percentage of - 52.5% At least 70% (i) adults consume (MANS 2014) adults consume sodium sodium <2000mg/ day3 <2000mg/ day Food group Servings per day % Meeting recommended servings Meat, poultry and egg (MANS 2014) < 1/2 1/2 to 2 > 2 20.1 66.8 13.1 Food group Servings per day % Meeting recommended servings Fish and fish products (MANS 2014) < 1 1 > 1 30.1 31.3 38.6 Food group Servings per day % Meeting recommended servings Legumes and nuts (MANS 2014) < 1/2 1/2 to 1 > 1 81.9 17.1 1 Food group Servings per day % Meeting recommended servings Milk and dairy products (MANS 2014) < 1 1 to 3 > 3 73.6 24.4 2 4 Indicators for the Comprehensive Global Monitoring Framework for the Prevention and Control of Non-Communicable Diseases 2014-2020 Food group Servings per day % Meeting recommended servings Fruits and Vegetables (NHMS 2015) < 5 >5 94.0% 6% 75 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 2.1 Percentage of Recommended At least (j) adults meeting intake: 65% meeting recommended 6-8 glasses recommended water water intake per day intake 2.1 Percentage of Reading NIP at At least (k) adults reading least 4 out of 7 12% read at least 4 the Nutrition nutrients nutrients Information (Including Panel (NIP) energy, excluding food additives) • Energy • Carbohydrate • Fat • Sodium • Vitamin • Mineral • Fibre Plain water intake (>18 years) Prevalence < 6 glasses/ day 27.1 6 – 8 glasses/ day 44.3 > 8 glasses/ day 28.6 Plain water intake (18-59 years) Prevalence (NHMS 2015) < 6 glasses/ day 26.0 6 – 8 glasses/ day 44.2 > 8 glasses/ day 29.8 Prevalence Reading NIP % of total (MANS 2014) Read below 4 nutrients 94.3% Read at least 4 nutrients 5.7% 3 Core indicators for the Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020 3 Preventing and Controlling Nutritional Deficiencies 3.2 Children below 5 years 3.1 Non-pregnantWomen 3.3 School Children 3.4 Food and Nutrition Security No. Indicator Definition Baseline data Target for improvement by the year 2025 3.1 Non-pregnant Women 3.1 Percentage of Anaemia: hemoglobin level 22.8% Not more than 11% (a) anaemia among <12g/dl (WHO 2006) (NHMS 2015) women in reproductive aged 15-49 years old1 3.1 Percentage of Low BMI: BMI <18.5kg/m2 8.2% Not more than 6% (b) women aged (WHO 1998) (NHMS 2015) 15-49 years old with low BMI2 76 National Plan of Action for Nutrition of Malaysia III, 2016-2025 1 Core indicators for the Global Nutrition Targets 2025 2 Additional indicators for the Global Monitoring Framework on Maternal, Infant and Young Child (IO5) 77 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 Prevalence of underweight (%) Public Health Significant <10 Low 10-19 Moderate (WHO 2006) Prevalence of stunting (%) Public Health Significant <20 Low 20-29 Moderate (WHO 2006) Prevalence of wasting (%) Public Health Significant <5 Acceptable 5-9 Poor (WHO 2006) 1 Core indicators for the Global Nutrition Targets 2025 3.2 Children (Age Below 5 Years Old) 3.2 Underweight Weight-for-age <-2SD 12.4% Not more than 5% (a) among children (NHMS 2015) below 5 years old 2.5% No increase (HIC, MOH 2015) from baseline data 3.2 Stunting among Height-for-age <-2SD 392,973 (17.7%) Not more than (b) children below (NHMS 2015) 250,000 (11%) 5 years old1 5,147 (1.55%) No increase (HIC, MOH 2015) from baseline data 3.2 Wasting among Weight-for-height <-2SD 8.0% Not more than 5% (c) children below (NHMS 2015) 5 years old1 BMI-for-age- <-2SD 1.9% No increase (HIC, MOH 2015) from baseline data 78 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 3.3 School Children (Age 5 -17 years old) 3.3 Prevalence of BMI for age <-2SD 9.0% Not more than 6% (a) thinness among (WHO 2007) (NHMS 2015) children 5-9 years old 3.3 Prevalence of BMI for age <-2SD 6.9% Not more than 5% (b) thinness among (WHO 2007) (NHMS 2015) children 10-14 years old 3.3 Prevalence of BMI for age <-2SD 7.0% Not more than 5% (c) thinness among (WHO 2007) (NHMS 2015) children 15 -17 years old No. Indicator Definition Baseline data Target for improvement by the year 2025 No. of parameters Prevalence (%) (MANS 2014) Food Quantity 25 Food Variety 26 Meal size 22 reduction Skip meals 15 Affordable by food 24 Could not 21 afford to feed children with variety food No. of parameters Target of prevalence (%) Food Quantity Not more than 15 Food Variety Not more than 15 Meal size Not more than 13 reduction Skip meals Not more than 9 Affordable by food Not more than 14 Could not Not more than 12 afford to feed children with variety food 3.4 Food and Nutrition Security Percentage of Food insecurity status based on household food identified parameters as below: insecurity 1. Food quantity 2. Food variety 3. Meal size reduction 4. Skip meals 5. Affordable buy food 6. Could not afford to feed children with variety food 4 Preventing and Controlling Obesity and Other Diet-Related Non-Communicable Diseases (NCDs) 4.2 School Children Obesity 4.1 Childhood Obesity 4.3 Adult Obesity 4.4 Elderly Obesity 4.5 Diet-Related Non Communicable Diseases (NCDs) 1 Core indicators for the Global Nutrition Targets 2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 4.1 Childhood Obesity 4.1 Prevalence of overweight BMI for age >2SD 7.6% No increase (a) among children below 5 (WHO 2006) (NHMS 2015) from baseline data years old1 4.1 Prevalence of obesity among BMI for age >3SD 3.7% No increase (b) children below 5 years old1 (WHO 2006) (NHMS 2015) from baseline data 79 National Plan of Action for Nutrition of Malaysia III, 2016-2025 80 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 4.2 School Children Obesity (aged 5 - 17 years old) 4.2 Prevalence of overweight BMI for age >1SD 26.8% No increase (a) among children aged (WHO 2007) (NHMS 2015) from baseline data 5-9 years old 4.2 Prevalence of obesity BMI for age >2SD 14.8% No increase (b) among children aged (WHO 2007) (NHMS 2015) from baseline data 5-9 years old 4.2 Prevalence of overweight BMI for age >1SD 30.4% No increase (c) among children aged (WHO 2007) (NHMS 2015) from baseline data 10-14 years old 4.2 Prevalence of obesity BMI for age >2SD 14.4% No increase (d) among children aged (WHO 2007) (NHMS 2015) from baseline data 10-14 years old 4.2 Prevalence of overweight BMI for age >1SD 24.0% No increase (e) among aged children (WHO 2007) (NHMS 2015) from baseline data 15-17 years old 4.2 Prevalence of obesity BMI for age >2SD 9.6% No increase (f) among children aged (WHO 2007) (NHMS 2015) from baseline data 15-17 years old 81 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Indicator Definition Baseline data Target for improvement by the year 2025 4.3 Adult Obesity 4.3 Prevalence of overweight Male: 31.6% No increase (a) among adults: Female: 28.3% from baseline data i. >18 years old and above Overall: 30.0% (NHMS 2015) BMI: 25.0-29.9 kg/m2 ii. 18-59 years old (WHO 1998) Male: 31.1% No increase Female: 27.7% from baseline data Overall: 29.5% (NHMS 2015) 4.3 Prevalence of obesity Male: 15.0% No increase (b) among adults: Female: 20.6% from baseline data i. >18 years old and above4 Overall: 17.7% (NHMS 2015) BMI: ≥ 30 kg/m2 ii. 18-59 years old (WHO 1998) Male: 15.4% No increase Female: 20.7% from baseline data Overall:17.9% (NHMS 2015) 4.3 Prevalence of abdominal Male: 38.2% No increase (c) obesity among adults. Female: 60.2% from baseline data i. >18 years old and above Overall: 48.6% Waist circumference: (NHMS 2015) Male ≥ 90cm, ii. 18-59 years old Female ≥ 80cm) Male: 25.0% No increase (WHO/ IOTF, 2000) Female: 57.7% from baseline data Overall: 40.0% (NHMS 2015) 4 Indicators for the Comprehensive Global Monitoring Framework for the Prevention and Control of Non-Communicable Diseases 2014-2020 82 National Plan of Action for Nutrition of Malaysia III, 2016-2025 4 Indicators for the Comprehensive Global Monitoring Framework for the Prevention and Control of Non-communicable 2014-2020 No. Indicator Definition Baseline data Target for improvement by the year 2025 4.4 Elderly Obesity 4.4 Prevalence of overweight BMI: 25.0-29.9 kg/m2 33.6% No increase (a) among elderly aged > 60 (WHO 1998) (NHMS 2015) from baseline data years old 4.4 Prevalence of obesity (BMI: ≥ 30 kg/m2) 15.7% No increase (b) among elderly aged > 60 (WHO 1998) (NHMS 2015) from baseline data years old No Indicators Definition Baseline data Target for improvement by the year 2025 4.5 Diet-Related Non-Communicable Diseases (NCDs) 4.5 Prevalence of Total cholesterol: 47.7% No increase (a) hypercholesterolemia ≥ 5.2 mmol/ L or 200 mg/ dl (NHMS 2015) from baseline data among adults aged 18 years old and obove4 83 National Plan of Action for Nutrition of Malaysia III, 2016-2025 4 Indicators for the Comprehensive Global Monitoring Framework for the Prevention and Control of Non-communicable 2014-2020 No. Indicator Definition Baseline data Target for improvement by the year 2025 4.5 Prevalence of diabetes Fasting plasma glucose 17.5% Not more than 15% (b) mellitus among adults aged concentration: (NHMS 2015) 18 years old and above4 ≥ 6.1 mmol/L or 110 mg/ dl) or on medication for raised blood glucose 4.5 Prevalence of hypertension As an average systolic blood 30.3% Not more than 24.0% (c) among adults aged 18 years pressure equal to or more (NHMS 2015) old and above4 than 140 mmHg and/ or diastolic blood pressure equal to or more than 90 mmHg or on medication for hypertension 84 National Plan of Action for Nutrition of Malaysia III, 2016-2025 85 National Plan of Action for Nutrition of Malaysia III, 2016-2025 Activities by Strategies of NPANM III, 2016-2025 • Foundation Strategy • Enabling Strategies • Facilitating Strategies 10.0 86 National Plan of Action for Nutrition of Malaysia III, 2016-2025 FOUNDATION STRATEGY Nutrition is not the sole responsibility of MOH and intervention programmes should also be implemented by other agencies. The foundation strategy of NPANM III highlights the importance of incorporating nutrition objectives, considerations and components into national development policies and action plans in other relevant agencies. This strategy also emphasises the need in ensuring the commitment and support of all the relevant agencies through National Food Safety and Nutrition Council (NFSNC), as well as and effective coordination and monitoring of the NPANM III, 2016-2025 by the National Coordinating Committee on Food and Nutrition (NCCFN). Incorporating Nutrition Objectives, Considerations and Components into National Development Policies and Action Plans 87 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Incorporate nutrition Number of higher level At least five meetings National Lead agency: and related agenda in meetings with nutrition with nutrition and State MOH higher level meetings and related agenda related agenda by MOH every year Other agencies: • Chief Minister’s All NCCFN and Meeting At least one meeting members • Post Cabinet per year with nutrition Meeting agenda by related • KSU’s meeting ministries/ agencies 2. To review and examine Percentage of At least 50% out of 10 National Lead agency: nutrition policy ministries and agencies relevant ministries and MOH statements and having nutrition policy agencies by 2025 programmes in the statements and Other agencies: development plans of programmes in their • MOF relevant ministries and development plans • JPM agencies for the 12th • EPU and 13th Malaysia Plans • ICU • MOE • MOA • MOYS • MWFCD • MUWHLG • MCMM • MRRD • MDTCC • MITI 3. Incorporate nutrition as Incorporation of Nutrition included as National Lead agency: one of the National nutrition objective in one of the National MOH Agro-food Policy the National Agro-food Agro-food Policy objectives Policy objectives by mid-term Other agency: review in 2015 and/ or MOA National Agro-food Policy II in 2020 4. Incorporate nutrition Number of At least one National Lead agency: component/ programmes including programme in other State • MOH consideration into other social protection ministries or agencies • ICU related programmes programmes in other incorporated with including social ministries or agencies nutrition component/ Other agencies: protection programmes incorporated with consideration yearly • MOE in various ministries or nutrition component/ • MWFCD agencies consideration • MRRD • NGOs • Other related ministries or agencies 88 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 5. Strengthen advocacy of Number of advocacy All relevant agencies National Lead agency: the NPANM III, 2016- activities and NGOs advocated State MOH 2025 to all relevant by 2018 District ministries, agencies and NGOs; • Conduct policy Number of dialogues/ At least three National Other agencies: dialogue/ advocacy workshops/ dialogues/ workshops/ State All ministries and conferences or conferences or agencies involved in • Develop Nutrition awareness programme awareness programme implementation of Policy Briefs related at national & state level NPANM III, 2016 to NPANM III, 2016 for the first three 2025 2025 for targeted years of NPANM, 2016 sectors, emphasising 2025 implementation on collaborative efforts Number of Nutrition At least three Policy National Policy Briefs published Briefs published by 2020 6. Ensure commitment and Number of nutrition At least one nutrition National Lead agency: support of all relevant related policies or related policies or All NFSNC agencies for nutrition papers presented papers presented by members through the National other ministries or Food Safety and agencies yearly Nutrition Council (NFSNC) 7. Ensure effective Number of At least one presentations National Lead agency: coordination and presentations related by other ministries or All NCCFN monitoring of NPANM with implementation agencies yearly in members III, 2016-2025 of NPANM III, NCCFN meeting through the National 2016-2025 activities Coordinating Committee by other ministries or on Food and Nutrition agencies (NCCFN) 8. Revise the National The National Nutrition The National Nutrition National Lead agency: Nutrition Policy of Policy of Malaysia Policy of Malaysia 2005 MOH Malaysia 2005 2005 revised revised by 2020 Other agency: Other related agencies 9. Establish the Technical The TWG for Food and The TWG for Food and National Lead agency: Working Group (TWG) Nutrition Security Nutrition Security MOH for Food and Nutrition established established by 2017 Security Other agency: MOA 89 National Plan of Action for Nutrition of Malaysia III, 2016-2025 90 National Plan of Action for Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 10. Strengthen collaboration Number of nutrition All programmes International Lead agency: with United Nations strategies and identified are National • United Nations agencies and ASEAN programmes implemented. (e.g: agencies (WHO, countries in collaborated with Country Programme UNICEF) implementing nutrition United Nation agencies Action Plan, WHO • ASEAN Sect. strategies and Programme Budget) • MOH programmes Other agency: • EPU • Other related ministries & agencies ENABLING STRATEGIES 91 National Plan of Action For Nutrition of Malaysia III, 2016-2025 92 National Plan of Action For Nutrition of Malaysia III, 2016-2025 ENABLING STRATEGY Recognising the importance of good nutrition during the first 1000 days of life, this strategy focuses on activities involving maternal, infant and young child feeding. The importance of the first 1000 days has always been highlighted to improve nutrition for mothers from pregnancy through the child’s 2nd birthday, when better nutrition can have a life-changing impact on a child’s future. The explicit target for each indicator has been set and can be achieved through promotional and intervention activities such as dietary advice, haematinic intake, strengthening breastfeeding promotion, cooking demonstration; rehabilitative activities such as distribution of full cream milk to mothers with inadequate weight gain. Promoting Maternal, Infant and Young Child Nutrition 93 National Plan of Action For Nutrition of Malaysia III, 2016-2025 1 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Supplement iron Proportion of women 100% of women State Lead agency: and folic acid to receiving iron and folic attending government District MOH pregnant mothers acid supplements health clinics received iron and folic acid supplementation 2. Set up SMS reminder/ SMS reminder/ SMS reminder/ State Lead agency: WhatsApp etc. on WhatsApp etc. WhatsApp etc. District MOH haematinic intake to all implemented implemented by 2020 antenatal mothers Other agencies: • MCMM • Tele Communication company 3. Monitor median urinary Median urinary iodine Biennial monitoring National Lead agency: iodine level among level among pregnant starting 2018 State MOH pregnant women in women in gazetted gazetted areas. Based areas monitored on the National Iodine Deficiency Disorder (IDD) Implementation Guidelines 4. Distribute full cream Percentage of poor 30% increment from State Lead agency: milk to poor mothers mother with baseline data by 2020 District MOH (total household income inadequate weight gain of below RM2000/ receiving full cream 50% increment from month) with inadequate milk baseline data by 2025 weight gain 5. Establish surveillance Surveillance database Surveillance National Lead agency: mechanism on maternal available mechanism for State MOH weight gain maternal weight gain developed by 2017 6. Develop Training Module developed Module develop by National Lead agency: Module on Therapeutic 2018 MOH Diet for pregnant women comprising: Other agencies: 1. Gestational • Universities Diabetes Mellitus • Professional 2. Under and over- Bodies nutrition 3. Anaemia 4. Hypertension 7. Provide training to Number of trainings At least one training State Lead agency: healthcare professional per state per year MOH using Training Module starting 2018 on Therapeutic Diet (Once the training module developed) 94 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 8. Conduct promotional Number of activities At least once per year National Lead agency: activities on exclusive conducted by related for each activity State MOH breastfeeding consistent agencies with the Code of Ethics Other agencies: for the Marketing of • MWFCD Infant Foods and • Breastfeeding Related Products: support groups • Dialogue/ forum • FMM • Convention/ • PUSPANITA Seminar • Professional • Advertisement Bodies through mass and • Related NGOs social media • Exhibition 9. Conduct counselling/ Percentage of mother At least 80% of State Lead agency: support on optimal of children aged 0-23 mothers of children District MOH breastfeeding to months received aged 0-23 months mothers of children counselling/ support at received counselling/ aged 0-23 months least once in the last support every year year starting 2018 10. Strengthen Baby Percentage of 100% government National Lead agency: Friendly Hospital government hospitals hospitals State MOH Initiative (BFHI) in implementing BFHI implementing BFHI hospitals using UNICEF/ Other agencies: WHO Global criteria • APHM Percentage of private Increase from 12% • Private hospitals implementing (2015) of BFHI hospitals BFHI implementation to 30% in 2020 and 50% in 2025 Percentage of births in Percentage of births in baby-friendly facilities baby-friendly facilities reported 11. Strengthen Baby Percentage of 50% by 2020 State Lead agency: Friendly Clinic (KRB) government health District MOH in government health clinics implementing 70% by 2025 clinic KRB 12. Implement mother- Percentage of 30% of workplace National Lead agency: friendly workplace workplaces adopting the Guideline • MWFCD guidelines prepared by implementing the on Mother-friendly • MOH the Companies guidelines workplace by 2020 Commission of Other agencies: Malaysia (Suruhanjaya 50% of workplace • All ministries Syarikat Malaysia) or adopting the Guideline and agencies other agencies on Mother-friendly Workplace by 2025 95 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 13. Provide breastfeeding Percentage of 20% increment of National Lead agencies: rooms in public breastfeeding rooms shopping complexes State • MUWHLG facilities at shopping complexes from baseline data by • Local 2020 Authorities 30% increment of Other agencies: shopping complexes • MDTCC from mid-term data by • MWFCD 2025 • PPPIM • MOH • PPKM Percentage of 20% of public Lead agency: breastfeeding space or transport station MOT rooms at public providing transport stations breastfeeding space Other agencies: or room by 2020 • MOH • MUWHLG 30% of public • Local transport station Authorities providing breastfeeding space or room by 2025 14. Establish Breastfeeding Breastfeeding Support Established by 2017 National Lead agency: Support Group (BFSG) Group Coordinating MOH Coordinating Committee Committee at national at national level level established Other agencies: • MBfPCA • PPPIM • PPPLM • Other related breastfeeding support groups 15. Adopt the International Duration of maternity Maternity leave for at National Lead agencies: Labour Organisation leave least 98 days by 2020 • MWFCD (ILO) for recommended maternity leave for at Other agencies: least 98 days • MOHR (16 weeks) • MDTCC • MOH National Plan of Action For Nutrition of Malaysia III, 2016-2025 96 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 16. Advocate private Number of private At least one private National Lead agency: employer to support employers been employer per year MWFCD female workers to advocated starting 2017 breastfeed by having: Other agencies: • 3 months paid • MOHR maternity leave OR • MDTCC extended leave • MOH period (combining • FMM paid/ unpaid or • Bank flexible paid leave) association • One or more • MTUC breastfeeding • FFC breaks or daily • MCMC reduction of working hours • Flexible working hours (part-time work schedule/ job sharing/ one-off task 17. Strengthen the Code Draft regulation By 2025 National Lead agency: of Ethics for the developed State MOH Marketing of Infant District Foods and Related Other agencies: Products through legal • MITI measure/ legislation • MDTCC • AGC • IBFAN 18. Promote complementary Number of promotion At least once per year National Lead agency: feeding through social & complementary feeding at each level State MOH mass media on social & mass District media Other agencies: • Related NGO • Breastfeeding support group • FMM • Professional bodies • KEMAS • MCMM National Plan of Action For Nutrition of Malaysia III, 2016-2025 97 98 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 19. Conduct nutrition Nutrition education 50% of clinics State Lead agencies: education sessions to sessions on infant and conducted education District MOH mothers and care givers young child nutrition session on infants based on Infant and conducted at clinic and young child Young Child Feeding level nutrition once a month Module by 2020 90% of clinics conducted education session on infants and young child nutrition once a month by 2025 ENABLING STRATEGY Recognising that inappropriate dietary practices are an important cause of nutritional problems. This strategy focuses on promotion to further increase awareness and practice of healthy eating which spans from toddlers to elderly. The activities are to be carried out in different settings and programmes such as child care centres, preschools, primary/ secondary schools, National Service Training Programme (PLKN), institutes of higher learning, welfare institutions and other institutions as well as community. Various activities have been identified under this strategy such as reviewing curriculum, develop teaching modules and guidelines, enforcement on banning sale of unhealthy food & beverages to children, strengthening existing nutrition programmes namely Healthy Community Kitchen, Healthy Eating through Healthy Shopping, Healthy Catering and Healthy Cafeteria. Whilst, “Back to Nature Programme” is a new initiative to inculcate fruit and vegetable intake especially to young children. This initiative uses NBOS approach by integrating nutrition components into other ministries’ programmes. All these activities are envisioned to improve nutritional status of population through healthy eating practices based on Malaysian Dietary Guidelines. This strategy also supports the implementation of National Children Health Plan of Action, National Adolescent Plan of Action, Salt Reduction Strategies for Malaysia and National Strategic Plan for Active Living. Promoting Healthy Eating and Active Living 99 National Plan of Action For Nutrition of Malaysia III, 2016-2025 2 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Childcare Centres 1.1 Involve parents in Number of childcare 10% for government State Lead agencies: promoting healthy centres conducting childcare centres by District • KEMAS eating such as during nutrition activities 2020 • MOH Meet The Parents Day, involving parents • JPNIN Parenting workshop etc 50% for government • PERMATA and 10% private childcare centres by Other agencies: 2025 • PPBM 1.2 Review Modul Kursus Modul Kursus Asuhan Nutrition component National Lead agencies: Asuhan & Didikan Awal & Didikan Awal in Modul Kursus • JPM/ UPM Permata Permata reviewed Asuhan & Didikan • MOH Awal Permata reviewed and updated Other agencies: by 2018 • JKM 1.3 Develop SOP for menu SOP developed By 2018 National Lead agency: preparation at childcare MOH centre Other agencies: • JKM • All related agencies 1.4 Establish monitoring Monitoring system Established by 2020 National Lead agency: system on provision of established MOH healthy menus at Taska Other agencies: • JKM • KEMAS • PPBM • PERMATA • JPNIN 1.5 Develop Training Training module Training module National Lead agency: Module for Food developed developed by 2018 MOH Handlers in Childcare Centre and Preschool Other agencies: on healthy eating and • KEMAS healthy meal • Chef preparation Association 100 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm, by year, by 2025) Implementation level Implementing agency 1.6 Train food handlers in Number of sessions Training started by National Lead agency: childcare centre on conducted 2020. At least one State MOH healthy eating and training per state healthy meal Other agencies: preparation • KEMAS • MOE • JKM • PPBM • Malaysia Association of Kindergarten 1.7 Make mandatory Healthy menu as a Healthy menu as a National Lead agency: provision of healthy prerequisite for prerequisite for • MOH menu as a prerequisite certification certification by 2020 • JKM for certification of childcare centre (Perakuan Pendaftaran Taska) 2. Preschoolers 2.1 Review healthy eating Review of nutrition Review completed by National Lead agencies component in preschool component in 2018 • MOE curriculum in line with preschool curriculum • MOH MOE planning completed In line with MOE’s planning Other agencies • Malaysia Association of Kindergarten • KEMAS • JPNIN 2.2 Train food handlers in Number of sessions Training started by National Lead agency: preschools on healthy conducted 2020. At least one State • MOH eating and healthy training per zone • KEMAS meal preparation (2020-2021) followed by at least Other agencies: one training per state • MOE (2022-2025) • JKM • JPNIN • PPBM • Malaysia Association of Kindergarten 101 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 2.3 Develop educational Number of educational At least one package National Lead agency: package on healthy package per year (at least 2 MOH eating (e.g. interactive, items per package) educational games) in Other agencies: line with MDG’s key • MOE messages for preschool • KEMAS • JPNIN • Malaysia Association of Kindergarten • NSM 2.4 Involve parents in Number of preschools 10% for government State Lead agencies: promoting healthy conducting nutrition preschool by 2020 District • MOE eating such as during activities involving • KEMAS Meet The Parents Day, parents 50% for government • MOH Parenting workshop etc and 10% private preschool by 2025 Other agencies: • JPNIN • Malaysia Association of Kindergarten 2.5 Conduct conference/ Number of At least once in five National Lead agency: convention on healthy conferences/ years MOH eating and active conventions/ living for children symposia/ seminars Other agencies: conducted • MOE • NGOs • NSM • Malaysia Association of Kindergarten • KEMAS • PTA 2.6 Integrate nutrition Programme guideline/ Programme guideline/ National Lead agencies: component into module developed and module developed State • MOH “Kebun Dapur Project” piloted by 2017 • KEMAS initiated by KEMAS Pilot implementation Others agency: carried out by zone • DOA in 2018 3. School Children 3.1 Revise Healthy School Revision of Healthy Revision completed National Lead agencies: Canteen Guidelines School Canteen by 2017-2018 • MOH Guidelines completed • MOE 102 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 3.2 Monitor the Percentage of primary At least 50% State Lead agency: implementation of and secondary schools compliance by 2025 District MOH School Canteen comply with the School Guidelines (nutrition Canteen Guidelines Other agency: component) (nutrition component) • MOE 3.3 Implement School Number of primary/ At least three schools State Lead agency: Meal Programme secondary schools in every state by 2020 District MOH implementing school meal programme At least six schools in Other agencies: every state by 2025 • MOE • PTA 3.4 Strengthen Coverage of Cumulative coverage: State Lead agency: enforcement on ban of enforcement District • MUWHLG sale of unhealthy foods/ 25% schools by 2016 • Local beverages to children authorities within 40 metres from 50% schools by 2018 school perimeter Other agency: 80% schools by 2025 • MOE 3.5 Initiatives to provide Number of schools Cumulative coverage: State Lead agencies: sign board or banner District • MUWHLG banning sale of 25% schools by 2017 • Local unhealthy foods/ authorities beverages to children 75% schools by 2020 within 40 metres of Other agencies: school perimeter 85% schools by 2025 • MOE • PTA 3.6 Enforce banning of Number of monitoring Enforced by 2017. State Lead agencies: marketing of unhealthy on enforcement District • MUWHLG food/ beverages to Cumulative coverage: • Local children in print and authorities fixed outdoor 25% schools by 2020 advertising within 50 Other agencies: metres of school 50% schools by 2025 • MOH perimeter (media, • MOE bus stops, billboards and other similar promotions) 3.7 Integrate nutrition Nutrition guideline to Nutrition guideline to State Lead agencies: component into “Projek be developed and be developed by 2018 District • DOA Pertanian Bandar” piloted initiated by Department Pilot implementation Other agencies: of Agriculture carried out by zone in • MOE 2019 • MOH 103 National Plan of Action For Nutrition of Malaysia III, 2016-2025 104 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 3.8 Train parents of Parent Number of schools 10,000 schools National Lead agencies: Teacher Association with trained PTA’s by 2018 State • MOH (PTA) members to members District • MOE promote healthy eating towards Number of trained At least 20,000 Other agency: healthy lifestyle PTA members by 2018 • PTAs 3.9 Implement healthy Number of healthy Starting 2019, at least National Lead agencies: eating activities through eating activities in one nutrition or health State • MOH PTA school by PTA related activity per District • MOE district per year Other agency: • PTA 3.10 Enhance nutrition Number of nutrition At least one nutrition National Lead agencies: promotion in schools promotion conducted promotion or health State • MOH including boarding in schools related activity per District • MOE schools school per year Other agencies: • Universities • Professional bodies • PTA 3.11 Develop educational Number of educational At least one package National Lead agency: package on healthy packages per year (at least two MOH eating (e.g. interactive, items per package) educational games) in Other agencies: line with MDG key • MOE messages for school • PTA children • Universities • NSM • MASO • MDA 3.12 Review nutrition Curriculum reviewed In line with MOE’s National Lead agency: component in school planning MOE curriculum Other agencies: • MOH • Universities • NSM • MASO • MDA 105 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 4. Boarding Schools 4.1 Revise standard menu Standard menu for Revision completed National Lead agency: for boarding schools boarding schools by 2018 • MOH under government • MOE agencies revised Other agencies: • State Department of Education • State Department of Health • MJSC • MOD (Royal Military College) • JAKIM (SMAR & SMAN) 4.2 Monitor the compliance Number of self- At least 5% of State Lead agency: of starndard menu monitoring food boarding schools District • MOH in boarding schools preparation (nutrition) under MOE’s • MOE in boarding school management monitored by 2020 Other agencies: • State Department of Education • State Department of Health • MJSC • MOD (Royal Military College) • JAKIM (SMAR & SMAN) 5. Institutes of Higher Learning 5.1 Carry out nutrition Number of nutrition At least one nutrition National Lead agency: promotion in institutes promotion conducted promotion activities State MOH of higher learning in public institute of conducted per year higher learning in 50% of public Other agencies: institute of higher • MDTCC learning in 2025 • MOHE starting 2018 • MOYS • Professional bodies: NSM/ NGOs No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 5.2 Revise/ establish the Revision completed Revision completed National Lead agency: nutrition component in by 2020 MOH PROSIS module and related club/ Other agencies: programme • MDTCC • MOHE • MOE • MOYS 5.3 Train of trainers (TOT) Number of TOTs At least one TOT National Lead agency: on healthy eating in conducted session per institute of State MOH PROSIS module and higher learning by related club/ 2020 Other agencies: programme • MDTCC • MOYS • MOHE • MOE • Student Council 5.4 Implement Healthy Number of healthy At least one healthy National Lead agency: Cafeteria in institutes cafeterias in institutes cafeteria in every State MOHE of higher learning of higher learning public university District by 2020 Other agencies: • MOH • Student Council 5.5 Develop educational Number of educational At least five new National Lead agency: materials on healthy material developed materials (electronic/ MOH eating targeted to softcopy/ video) students in institute of developed by 2025 Other agencies: higher learning • MOHE • Student Council 5.6 Conduct healthy meal Number of activities At least one activity National Lead agencies: preparation activity (i.e: conducted conducted per year in • NSM seminar, chef institute of higher • MASO competition) for culinary learning offering • MDA student in institute of culinary or related • CAM higher learning courses Other agencies: • MOH • MOHR • MOHE • Institut Kemahiran Belia Negara 106 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 6. National Service Training Programmes (PLKN) 6.1 Adopt nutrition Adoption of nutrition Adopted by 2018 National Lead agencies: consideration as one of consideration into • JLKN the mandatory criteria contract procurement • MOH in National Service Training Programme Other agency: (PLKN) management • Persatuan contract procurement Pengusaha Kem PLKN 6.2 Monitor compliance of Percentage of camps 90% by 2018 State Lead agency: menu in PLKN achieving excellent District • JLKN status 95% by 2020 • MOH Other agencies: • Persatuan Pengusaha Kem PLKN 6.3 Conduct nutrition talk Number of nutrition At least one talk per State Lead agencies: during orientation week talks during session per camp District • MOH in PLKN camp orientation week • JLKN 7. Other Institutions 7.1 Review menu in Number of menu At least one menu National Lead agency: selected institutions reviewed reviewed every year MOH (i.e: prisons, Pusat Pemulihan Dalam Other agencies: Komuniti (PDK), elderly • MOHA homes, orphanage • JKM homes) • MWFCD • Other private institutions 7.2 Monitor compliance of Number of monitoring At least once per year National Lead agency: menu in selected activities per institution per state State MOH institutions starting 2018 (i.e: prisons, Pusat Other agencies: Pemulihan Dalam • MOHA Komuniti (PDK), elderly • JKM homes, orphanage • MWFCD homes) • Other private institutions 107 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 8. Community 8.1 Mandatory Percentage of healthy 100% in government National Lead agency: implementation of cafeteria health facilities by State MOH healthy cafeteria at 2018 District work places • Government health Number of new private At least two new Other agencies: facilities sectors or other private sectors or other • APHM government agencies government agencies • JPA • Private hospitals & implementing healthy per year • Other other government cafeteria government facilities agencies and private sectors. 8.2 Mandatory PHSSM implemented All Division in MOH National Lead agency: implementation of in all ministries Headquarters MOH Healthy Meal Provision implemented PHSSM during Meetings by 2020 Other agencies: (PHSSM) in • JPA all ministries 50% other ministries • All ministries at national level (at least one Division) implemented PHSSM by 2020 8.3 Promote nutrition Number of nutrition At least seven nutrition National Lead agency: activities via mass promotion activities messages by category State MOH media and social media via mass media and (age group, specific based on the Malaysian social media topic) promoted per Other agencies: Dietary Guidelines year • State Health (including Malaysian Department Healthy Plate) • MCMM • Persatuan Penerbit • Universities • Professional Bodies/ NGO 8.4 Conduct advocacy and Number of advocacy At least six different National Lead agency: awareness on Malaysian and awareness activities advocating State MOH Healthy Plate concept activities Malaysian Healthy Plate District through various nutrition- concept per state per Other agencies: related activities such as year Professional Healthy Shopping Tour/ bodies Healthy Cafeteria/ Healthy Catering/ PHSSM/ nutrition counselling/ talks/ exhibitions/ nutrition intervention in KOSPEN/ nutrition promotion in school 108 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 8.5 Expand existing Healthy Number of shopping At least 60 outlets by State Lead agency: Eating Through Healthy outlets involved in 2018 • MOH Shopping Programme Healthy Eating Through • MDTCC to more shopping outlet Healthy Shopping chains Programme Other agencies: • FOMCA • Related supermarkets 8.6 Empower consumers Number of 40,000 downloaders National Lead agencies: through digital downloaders (mobile) by 2020 State MOH technology (5000 downloaders (i.e. MyNutriDiari apps) annually) Other agencies: • JPA • MAMPU 8.7 Strengthen Nutrition Number of NICs 28 NICs by 2020 National Lead agency: Information Centres established State MOH (NIC) Other agencies: • Other ministries • Universities 8.8 Strengthen Healthy Number of Healthy 51 Healthy Community State Lead agency: Community Kitchen Community Kitchens Kitchens by 2020 District MOH (DSM) Number of activities At least 24 activities Other agencies: conducted in healthy conducted per DSM • KEMAS community kitchen per year • DOA 8.9 Carry out nutrition Number of nutrition 10 activities per year National Lead agency: promotion to the promotion activities at all level State MOH community focusing conducted on:- Other agencies: • Creating a calorie • NSM conscious society • MASO (i.e.: R&R and • MDA hotels) • All nutrition • Increase fruit & related vegetable intake professional • Reduce salt & sugar bodies/ NGO 8.10 Review Healthy Catering Module reviewed Healthy Catering National Lead agency: Training Module Training Module State MOH reviewed by 2018 District Conduct training on Number of training At least one training per Healthy Catering year at district level Module 109 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 8.11 Integrate nutrition Number of national At least two national National Lead agencies: component in sport sport events integrated sport events integrated • MOH events such as Fit with nutrition with nutrition • MOYS Malaysia, Hari Sukan component component every • MOE Negara year starting 2017 8.12 Integrate nutrition Nutrition consideration Nutrition consideration National Lead agency: consideration in included as one of the included as an approval MOH procurement of supply approval criteria in criteria for new for cooked food in procurement of supply Government Cafeteria Other agencies: government institution for cooked food in Tender application in: • JLKN as an approval criteria government institution • MOHE for new Government • MOH by 2017 • INTAN Cafeteria Tender • INTAN by 2018 application • PLKN by 2019 • MOHE by 2020 110 National Plan of Action For Nutrition of Malaysia III, 2016-2025 ENABLING STRATEGY 111 National Plan of Action For Nutrition of Malaysia III, 2016-2025 Nutritional deficiencies among the vulnerable groups (women, children and elderly) will be addressed in this strategy. Emphasis will be given to anaemia among women of reproductive age, iodine deficiency, protein energy malnutrition (PEM) among Malaysian as well as stunting and wasting in children. Activities under this strategy will include an overall landscape analysis on malnutrition status among children to support in modifying existing nutrition strategies and programmes. Apart from that, this strategy includes activities on development of food fortification policy such as implementation of Universal Salt Iodisation (USI) and fortification of wheat flour with iron and folic acid. Continuous collaboration with MOE for the National Supplementary Feeding Programmes such as School Supplementary Feeding and School Milk Programme is still vital. There will be continued training among health care providers and care givers to increase nutrition management skills of children below 5 years. Preventing and Controlling Nutritional Deficiencies 3 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Women 1.1 Develop a Guideline on Guideline developed Guideline developed National Lead agency: Anaemia Prevention & by 2017 MOH Control Programme among Women of Reproductive Age 1.2. Carry out nutrition Number of nutrition One nutrition education District Lead agency: education specifically education activities in at least one MOH on the importance of conducted KOSPEN’s locality micronutrients for per district per year Other agencies: women of • KEMAS reproductive age • NGOs (15-49 years old) • Professional bodies • Universities 1.3 Implement mandatory Iron and folic acid Implemented by 2020 National Lead agency: iron and folic acid fortification of wheat MOH fortification of wheat flour implemented flour Other agencies: • MDTCC • Millers • FFM 1.4 Provide Percentage coverage At least 50% of State Lead agency: supplementation of of iron and folic acid prioritised areas MOH iron and folic acid to supplementation to covered by 2025 secondary school aged secondary school aged Other agencies: (>15 years old) (>15 years old) • MOE adolescent girls in adolescent girl in • JAKOA prioritised areas prioritised areas • State government Percentage of All identified school identified school aged aged adolescent girls adolescent girl given given supplement by supplement 2025 2. Children 6 Years Old and Below 2.1 Report analysis on Landscape analysis of Report developed National Lead agency: malnutrition landscape malnutrition among by 2018 • UNICEF among children under children reported • MOH 5 years old to support in modifying existing nutrition strategies and programmes 112 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 2.2 Identify effective Strategies identified Strategies to address National Lead agency: strategies to address stunting and wasting • UNICEF stunting and wasting among children under • MOH among under 5 years 5 years old children old children identified by 2019 Other agencies: • MOE • KEMAS • Professional bodies • Other related ministries & NGOs 2.3 Strengthen Nutrition Evaluation of PPKZM Evaluation on National Lead agency: Rehabilitation of effectiveness of • UPM Malnourished Children PPKZM conducted • MOH Programme (PPKZM) and reported by 2017 Recommendation Recommendation to proposed improve PPKZM proposed based on evaluation findings 2.4 Strengthen management National Referral National Referral National Lead agency: of referral system for System established System established MOH System for Severe Acute by 2020 Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) 3. School Children 3.1 Strengthen the Percentage of school 50% of school with the State Lead agency: implementation of the with the School School Supplementary District MOE School Supplementary Supplementary Feeding Programme Feeding Programme Feeding Programme (RMT) monitored Other agency: (RMT) for targeted (RMT) monitored by 2020 MOH school children 3.2 Carry out evaluation of Evaluation of the The PS1M evaluated National Lead agency: the School Milk PS1M by 2020 MOE Program (PS1M) Other agency: MOH 3.3 Monitor median urinary Median urinary iodine Biennial monitoring National Lead agency: iodine excretion level excretion: by 2018 State MOH among school children 100-199 µg/L aged 8 to 10 years old (After gazzettment of Other agency: USI for the whole MOE Malaysia, expected 2018) 113 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency National Plan of Action For Nutrition of Malaysia III, 2016-2025 114 4. All Age Groups 4.1 Implement Universal USI is implemented Implemented by 2018 National Lead agency: Salt Iodisation (USI) for State MOH the whole country 4.2 Carry out awareness Number of awareness Awareness campaign National Lead agency: campaign on campaigns carried out on consumption of State MOH consumption of iodized iodized salt carried salt in Peninsular out within one year of Malaysia and Labuan gazettement in Peninsular Malaysia and Labuan 4.3 Provide cash/ food Number of cash/ food Number of cash/ food National Lead agency: transfers to vulnerable transfer programmes transfer programmes JPM groups to improve increased yearly nutritional status (i.e.: Other agencies: school children from • MOA poor family) • NGOs • MOE • MWFCD • MRRD 4.4 Strengthen community Number of new Three new Community State Lead agency: based treatment Community Feeding Feeding Centres MOH through expansion of Centres established per year Community Feeding Other agency: Programme (PCF) JAKOA 4.5. Develop SOP related to SOP developed SOP developed National Lead agency: nutritional management by 2018 MKN for supplementary feeding for all age Other agencies: groups during disasters • MOH and emergencies • JKM • State Government • APM • NGO’s ENABLING STRATEGY National Plan of Action For Nutrition of Malaysia III, 2016-2025 115 Diet-related non-communicable diseases (NCDs) have contributed to the overall disease burden in the country for several decades. Although public awareness has been improving, unfortunately, readiness to change unhealthy eating habits and sedentary lifestyle and be responsible for their own health is still seriously looking. Therefore, there is a need for stronger soft and hard policies that will support and facilitate healthier behavioural change among the population. Some of the suggested hard policies to be implemented in this Plan are policies on healthy BMI as part of performance appraisal, ban television advertisement on unhealthy food to children, impose tax to sugar sweetened beverages, mandatory restriction of food outlet operating hours. Besides that, Guidelines on Weight Management Programme for Overweight and Obese Person will be established as a community intervention programme. The community will be empowered through KOSPEN in combating these emerging problems. Compliance to the Malaysia Pledge (Malaysian Food and Beverages Industry’s “Responsible Advertising to Children” Initiative) will be monitored and guideline to regulate marketing of food and non-alcoholic beverages will be established. Preventing and Controlling Obesity and Other Diet-Related Non-Communicable Diseases (NCDs) 4 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Make available self- Number of 100% in all ministries National Lead agency: screening equipment for government agencies by 2020 MOH NCD risk factors with self-screening (weighing machines, equipment Other agencies: stadiometer, BP set, • All ministries glucometer) through • JPA KOSPEN activity at workplace 2. Develop policy on One policy developed Policy developed National Lead agency: healthy BMI as part of by 2018 MOH performance appraisal at workplace for Other agencies: government and private • JPA sector • MOHR 3. Develop standard Standard guideline Standard guideline National Lead agency: Guideline on Weight developed developed by 2017 MOH Management Programme for Overweight & Obese Individual at Workplace 4. Implement Weight Number of government At least three of National Other agencies: Management and private agencies government and State MOH Programme for implement weight private agencies Overweight & Obese management implemented the Lead agency: Individuals at Workplace programme programme per year All government ministries and agencies. 5. Promote healthy eating Number of healthy Healthy eating National Lead agency: through social media eating messages messages for the State MOH (Facebook, Twitter, covered in social prevention & control Blog, Instagram etc.) media of obesity covered in Other agencies: for the prevention & at least 10 posts per • MCMC control of obesity month • Professional bodies 6. Ban television Review and upgrade Regulation established National Lead agencies: advertising of foods/ current guideline into by 2020 • MOH beverages high in fat regulation • MCMC and/or high in sugar and salt for children Other agency: • FMM • Fast food industries 116 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 7. Reduce cooking oil Percentage of subsidy 20% subsidy reduction National Lead agency: subsidy reduction by 2025 MOF Other agencies: • MOH • MPIC • MDTCC 8. Impose healthy catering Healthy catering Healthy catering National Lead agency: training as a prerequisite training adopted as a training adopted as a Local authority for business license prerequisite for prerequisite for application (food & business license business license Other agency: beverage) application (food & application (food & MOH beverage) beverage) by 2025 9. Impose tax on unhealthy Tax on unhealthy foods Tax on unhealthy foods National Lead agency: foods and beverages and beverages (SSBs) and beverages (SSBs) MOF (i.e: sweetened creamer, implemented by 2020 condensed milk, sugar Other agencies: sweetened beverages • Custom (SSBs) including Department carbonated drinks and • MOH processed foods • Food industries 10. Establish guideline and Guideline established. Guideline established Nationwide Lead agency: implement mandatory by 2017 MOH display prominently of nutrition information on Mandatory nutrition Gazzetted by 2025 Other agencies: menu at food outlets information on menu Fast food industries (e.g: franchise fast food at food outlets restaurants) gazzetted 11. Voluntary commitment Number of fast food At least two fast food National Lead agency: to reduce serving size/ companies committed companies committed MOH value meals or restrict per year size/refilling/value meal Other agencies: by fast food companies Fast food industries 12. Impose mandatory Guidelines established Guidelines established National Lead agencies: requirement for vending by 2020 • MUWHLG machine to sell • Local healthier beverage Mandatory healthy Gazzetted by 2025 Authorities options in public places vending machine to sell healthier beverage Other agency: options in public MOH places gazzetted 117 National Plan of Action For Nutrition of Malaysia III, 2016-2025 118 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 13. Impose mandatory Gazzettment on Gazzetted by 2020 National Lead agency: restriction of operating restriction of operating • JPM hours up to 12 midnight hours up to 12 Enforced by 2021 • MOH for all food outlets midnight for all food outlets Other agencies: • MOHA • MUWHLG • Local authorities • Fast food industries 14. Empower KOSPEN Number of KOSPEN 100% KOSPEN State Lead agency: volunteers to conduct volunteers trained in the volunteers trained in District MOH Weight Management Weight Management identified locality per Programme in Programme district Other Agencies community to combat • MRRD obesity and other diet Number of Weight At least one • MOYS related NCDs Management programme conducted • Professional Programmes in one KOSPEN bodies conducted by locality per district per • Panel Penasihat KOSPEN volunteers year (MOH) 15. Develop specific Specific nutrition Developed specific National Lead agency: nutrition criteria for criteria developed nutrition criteria FMM monitoring of the by 2017 Malaysia Pledge Other agency: (Malaysian Food and Monitoring system 100% adherent to the • MOH Beverage Industry’s established pledge per year • Food industries “Responsible Advertising starting 2018 including fast to Children” Initiative) food Number of new At least two new companies signing the companies per year Pledge starting 2018 16. Regulate the Guideline to regulate Guideline established National Lead agency: marketing of food and marketing of food by 2020 • MOH non-alcoholic and non-alcoholic beverages to children beverages to children Other agencies: • MDTCC Gazzettment of the Regulation gazzetted • MCMC regulation by 2025 • FMM • Food industries including fast food ENABLING STRATEGY An important objective of NPANM III is to strengthen food and nutrition security of the population, which has become a global agenda. All activities outlined under this strategy contribute to the sustainable food system encompassing from farm to table. One of the major key activities for sustaining food systems to promote healthy diet is to incorporate nutrition consideration into planning of food supply for the country. Under this strategy, collaboration with the Ministry of Agriculture and Agro-Based Industry will be strengthened in making agriculture system more nutrition enhancing. There is also a need to revisit the national food system policies including food production, distribution, marketing and purchasing to provide more effective and supportive food system. Food industries also play a major role in implementing this strategy to produce more and healthier food and beverage products at affordable prices through reformulation and innovation. A sustainable food system to promote healthy diets contributes significantly in achieving the optimal nutritional well-being of Malaysians. This strategy supports the implementation of National Agrofood Policy and National Sustainable Consumption Blueprint (2015-2030). Sustaining Food Systems to Promote Healthy Diets 119 National Plan of Action For Nutrition of Malaysia III, 2016-2025 5 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Integrate nutrition Nutrition component Incorporated in the National Lead agency: component in the considered in the Second National Agro MOA planning of food supply planning of food Food Policy (NAP), for the population supply for the 2021-2030 Other agencies: population • MOH • EPU • Universities 2. Adopt Nutrition Nutrition Enhancing Adopted by MOA National Lead agency: Enhancing Agriculture- Agriculture-Food by 2021 MOH Food Supply Calculator Supply Calculator developed and adopted Other agencies: • MOA • EPU • Universities 3. Advocate the Number of advocacy At least 15 advocacy National Lead agency: establishment on activities on community activities on community State DOA community gardening gardening carried out gardening carried out yearly at national/ Other agencies: state level • MOE • MOH • MDTCC • NGOs • MRRD • MUWHLG • MWFCD 4. Advocate to increase Locally produced Annual increase in the National Lead agency: local production of fruits and vegetables quantity of locally MOA fruits and vegetables increased produced fruits and vegetables Other agencies: • FAMA • MARDI • MOH • SMEs • Universities • MUWHLG • MRRD 5. Promote the Number of promotions Annual increase in the National Lead agency: consumption of on the consumption of number of promotions MOA underutilised crops underutilised crops on the consumption (i.e.: pulasan, kuini, carried out of underutilised crops Other agencies: binjai, ceri • FAMA Terengganu, asam • MARDI gelugor, terung asam, • MOH bambangan, sagu, • SMEs sukun) • Universities • MRRD 120 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 6. Establish a guideline on Guideline established Guideline established National Lead agencies: food supply and by 2018 • MOH distribution according to • MKN nutrition requirement during crisis/ Other agencies: emergency • JPAM • JKM • MOH • MOA • Universities 7. Increase the production Number of foods and At least 15 products National Lead agency: and promotion of beverages with formulated/ FMM healthier foods and reduced/ low sugar/ reformulated per year beverages sodium/ fat or Other agencies: increased/ higher in • MOH fibre • SMEs 8. Increase consumption Database of production Increase yearly National Lead agencies: of the following of healthier foods and production for the • FMM healthier foods and beverages by industry following healthier • F&B beverages by food/ beverages: consumers: • Wholemeal bread • Wholemeal bread Other agencies: • Low sugar • Low sugar • MDTCC beverages beverages • MOH • Whole grains • Whole grains • Hypermarket cereals cereals chains. • Whole grains • Whole grains biscuits biscuits • Low fat milk • Low fat milk 9. Implement zero GST for Zero GST for whole Zero GST for whole National Lead agency: whole grains products grains products with grains products with MOF with Healthier Choice Healthier Choice Logo Healthier Choice Logo Logo (HCL) (HCL) implemented (HCL) implemented Other agency: by 2020 • MOH • FMM • MDTCC • Custom Department 10. Implement Healthier Number of products At least 10% for each National Lead agency: Choice Logo (HCL) with Healthier Choice food product category MOH Logo (HCL) in 2017-2020 Other agency: At least 20% for each • F&B product category in • FMM 2021-2025 • SMEs 121 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 11. Provide incentives Incentive (fiscal/ non- Incentive (fiscal/ non- National Lead agency: (i.e. tax discount for fiscal) to fiscal) to MOF producer for local manufacturers with manufacturers with production, processing healthier food healthier food Other agency: and distribution or products provided products provided • EPU importation and by 2020 • MDTCC marketing of healthier • Custom food options) Department • MIDA • MOH • FMM • MOSTI • MOA • MITI • Fast food industries 12. Implement tax incentive Tax incentive for Additional tax incentive National Lead agency: for manufacturers with manufacturers with for manufacturers with MIDA R&D facilities in R&D facilities in R&D facilities in Malaysia for healthier Malaysia for healthier Malaysia for healthier Other agency: food products food products food products • MOF implemented implemented by 2021 • EPU • MDTCC • Custom Department • MOH • FMM • MOSTI • Fast food industries 13. Increase the number of Number of food Annual increase in the National Lead agency: Fair Price Shop (Kedai premises with Fair number of food MDTCC Harga Patut) premises Price Shop increased premises with Fair selling food item Price Shop 14. Increase accessibility to Number of Pasar Tani/ Annual increase in the National Lead agency: affordable fruits and Pasar Tamu/ Pasar number of Pasar Tani/ MOA vegetables Malam or equivalent Pasar Tamu/ Pasar outlets selling fruits Malam or equivalent Other agencies: and vegetables outlets selling fruits • FAMA and vegetables • Persatuan Penjaja 122 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 15. Formulate policy to Food wastage policy Food wastage policy National Lead agencies: reduce food wastage formulated formulated by 2018 • MUWHLG • MARDI Other agencies: • MCMM • MOH • MOE • Tourism • NGOs 16. Carry out media Number of media At least one annual National Lead agencies: campaign on reduction campaign on reduction media campaign on State • MUWHLG of food wastage of food wastage reduction of food • MARDI carried out wastage carried out • MCMM Other agencies: • MOE • MOH • MOTAC • NGOs 123 National Plan of Action For Nutrition of Malaysia III, 2016-2025 124 National Plan of Action For Nutrition of Malaysia III, 2016-2025 ENABLING STRATEGY Supporting efforts to promote food safety and quality is an essential component to support NPANM III. Activities under this strategy include educating and improving awareness of the population on food labelling, food safety and consumer rights. Mandatory declaration of total sugar, sodium and main fatty acids are proposed in this strategy as well. The expansion of nutrition labelling is to empower consumers in making informed choices about food products for healthy dietary practices. Supporting Efforts to Promote Food Safety and Quality 125 National Plan of Action For Nutrition of Malaysia III, 2016-2025 6 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Educate consumers on Percentage of adults Increase percentage of National Lead agency: nutrition labelling read nutrition label adults read nutrition State MOH label compared to baseline data Other agencies: • MCMM (MANS, 2014: 5.7% • MDTCC read at least 4 • Food industry nutrients) • Professional bodies • FOMCA • Mass media • Private company. 2. Impose mandatory Mandatory declaration All food categories that National Lead agency: declaration of total of total sugars in all require mandatory MOH sugars in all food food product nutrition labelling products (in stages) implemented in stages (refer to Guide to Other agencies: Nutrition Labelling • FMM and Claims, 2010) • SMEs by 2020 Other selected food categories by 2025 3. Impose mandatory Mandatory declaration All food categories that National Lead agency: declaration of sodium implemented require mandatory MOH in all food products nutrition labelling (in stages) (refer to Guide to Other agencies: Nutrition Labelling • FMM and Claims, 2010) • SMEs by 2020 Other selected food categories by 2025 4. Impose mandatory Mandatory declaration Mandatory declaration National Lead agency: declaration of four main implemented of four main types of MOH types of fatty acids fatty acids for four (saturated, food categories Other agencies: monounsaturated, by 2020: • FMM polyunsaturated & • Salad dressing • SMEs trans fatty acid) in • Flour selected food products Confectionery • Milk • Cereal (Based on Guide to Nutrition Labelling and Claims, 2010) 126 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 5. Expansion of mandatory Mandatory nutrition Mandatory nutrition National Lead agency: nutrition labelling for labelling for processed labelling for processed MOH processed food and food implemented food by 2020 beverages (sauces, fat Other agencies: spread products, ice • FMM confection and etc.) as • SMEs sold in retail outlet 6. Strengthen the voluntary Number of SKU with More than 50 Stock National Lead agency: implementation of FOP for Energy Keeping Units (SKUs) • FMM voluntary of Front-of- per year in 2016-2025 • F&B Pack (FOP) for Energy Baseline: Other agencies: 2012 – 186 SKUs • MOH 2013 & 2014 – • SMEs 380 SKUs 127 National Plan of Action For Nutrition of Malaysia III, 2016-2025 128 National Plan of Action For Nutrition of Malaysia III, 2016-2025 FACILITATING STRATEGIES 129 National Plan of Action For Nutrition of Malaysia III, 2016-2025 130 National Plan of Action For Nutrition of Malaysia III, 2016-2025 FACILITATING STRATEGY Standard dietary guidelines are important to ensure consistent and accurate nutrition messages to the public. These have been developed through general consensus of expertise from related sectors and disseminated to the population by health care professionals. The guidelines provide dietary advice suited with the dietary needs of the various age groups and culturally sensitive for Malaysian communities. These guidelines not only address issues of nutrient insufficiency in diet but also provide information on healthy eating to reduce risk of over-nutrition and non-communicable diseases. The dietary guidelines will be reviewed every 10th year to ensure the relevance of the technical information and the prevailing nutrition situation in the country. The revision of Recommended Nutrient Intake (RNI), 2005 will provide latest advice on dietary intake for the maintenance of good health. The RNI covers all age groups from infancy to elderly including pregnant and lactating women as well. Providing Standard Nutrition Guidelines for Various Targeted Groups 1 131 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Develop comprehensive Guideline developed Guideline developed National Lead agency: nutritional guideline for by 2018 MOH children with special needs for healthcare Other agency: providers JKM 2 Develop Dietary Guideline developed Guideline developed National Lead agency: Guideline for Pregnant by 2018 MOH & Lactating Women Other agencies: • MWFCD • LPPKN • JKM • Universities • Professional bodies 3. Develop Dietary Guideline developed Guideline developed National Lead agency: Guideline for Elderly by 2018 MOH Other agencies: • MWFCD • JKM • Universities • NGOs • Professional bodies 4. Develop Dietary Guideline developed Guideline developed National Lead agency: Guideline for by 2018 MOH Vegetarian Other agencies: • Universities • NGOs • Professional bodies 5. Review all guidelines Guideline reviewed RNI 2005 reviewed National Lead agency: and recommendations by 2018 MOH at least once every ten years e.g. RNI, MDG MDG 2010 reviewed Other agencies: by 2020 • Universities • Research MDG for Children & Institutes Adolescents 2013 • Professional (include Guidelines for bodies the feeding of infants & young children) reviewed by 2023 National Plan of Action For Nutrition of Malaysia III, 2016-2025 132 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 6. Review all nutrition All training modules All training modules National Lead agency: training modules reviewed reviewed in tandem MOH in tandem with revision with revision of of nutritional guidelines nutritional guidelines Other agencies: and recommendations and recommendations • Universities by 2025 • Research Institutes National Plan of Action For Nutrition of Malaysia III, 2016-2025 133 134 National Plan of Action For Nutrition of Malaysia III, 2016-2025 FACILITATING STRATEGY Continuous assessment and monitoring of the country’s nutrition situation enable the characterisation of the nutritional problems faced by the population and detecting changes in the nutrition situation. Such information is vital for the planning and implementation of more targeted intervention programmes. The need for strengthening the national nutrition surveillance systems for specific groups are given attention in this strategy. Whilst, for the purpose of country accountability, commitments to the global and regional nutrition parameters and frameworks, this information will be periodically reported to the related UN agencies. Continuous Assessment and Monitoring of the Nutrition Situation 2 135 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Monitor prevalence of Prevalence of Prevalence of National Lead agency: diarrhoea in children diarrhoea in diarrhoea monitored State MOH under 5 years old children under 5 and reported yearly years old 2. Continue nutrition surveillance Nutrition Nutrition surveillance National Lead agencies: for children aged 4 to 6 years surveillance reported by: • KEMAS old in government preschools regularly • MOE conducted and KEMAS • MOH reported • three times/ year MOE • At least once a year 3. Strengthen monitoring of BMI Nutritional status Nutritional status National Lead agency: among school children through (BMI) monitored (BMI) monitored yearly State MOE SEGAK/ Student Health and reported and reported Record (RKM) Other agency: MOH 4. Strengthen monitoring of BMI Nutritional status At entry and before National Lead agency: among National Service Training (BMI) monitored exit the programme State MOH Programme (PLKN) trainees and reported Other agency: JLKN 5. Make periodic reporting Number of All national progress to International Lead agency: of national progress to UN/ reportings UN/ WHO/ WPRO/ National MOH WHO/ WPRO/ ASEAN on the ASEAN on the global following global and regional and regional nutrition Other agencies: nutrition parameters/ framework parameters/ framework • MOA for action including: for action reported • EPU • Global Nutrition Targets 2025 • WHO • Monitoring Framework for • UN Maternal, Infant and Young agencies Child • Asean • Framework for Action for Countries ICN2 • Sustainable Development Goals (SDGs) 2030 • Global Action Plan for the Prevention and Control of NCD 2013-2020 • ASEAN Integrated Food Security (AIFS) Framework and Strategic Plan • Action Plan to Reduce the Double Burden of Malnutrition in the Western Pacific Region 2015-2020 136 National Plan of Action For Nutrition of Malaysia III, 2016-2025 FACILITATING STRATEGY Research and development are important to provide evidence for the development of policies and programmes. The importance of conducting periodic and comprehensive national nutrition surveys for all age groups is given emphasis. The establishment of Nutrition Research Priorities (NRP) for the 11th and 12th Malaysia Plans will give a clear direction of nutrition research in the country and fund allocation. It is crucial to update the Malaysian Food Composition Database (FCD), 1997. The updated Malaysian FCD will provide better quality nutrient data especially for health professionals, food scientists, food industries and etc. In the way forward to support nutrition research development in the country, the establishment of the National Institute of Nutrition (NIN) is identified as one of the strategies to strengthen capacity building in nutrition research and establish smart partnership with relevant key stakeholders involved in research. Strengthening Food and Nutrition Research and Development 3 137 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Establish Nutrition Nutrition Research Nutrition Research National Lead agency: Research Priorities Priorities established Priorities for 11th &12th MOH (NRP) for 11th and 12th MP established Malaysia Plan (MP) Other agencies: • Universities • ASM • Research Institutes • MOSTI • Other related agencies 2. Conduct periodic and Number of national At least once in five National Lead agencies: comprehensive national survey as stipulated in years • MOH nutrition surveys for all NRP • Other identified age groups as stipulated research in Nutrition Research institute/ Priorities for Malaysia agencies (NRP) 3. Conduct national survey National survey National survey National Lead agencies: for micronutrient status conducted conducted by 2025 • MOH for iron, vitamin A and • Other identified vitamin D using research biochemical parameters institute/ among children under 5 agencies years old 4. Strengthen capacity Percentage of At least 30% National Lead agency: building in postgraduate nutritionists trained in nutritionists trained in MOH nutrition research postgraduate nutrition postgraduate nutrition research research by 2025 Other agencies: • Universities • Research Institutes 5. Incorporate nutrition Number of national At least three national National Lead agencies: components into surveys/ research surveys/ research • DOS national surveys/ incorporating with incorporating with • MWFCD research by other nutrition component nutrition component • MOA agencies, i.e. Malaysian by other agencies • MOH Family Life Survey by 2025 (LPPKN), Household Other agencies: Expenditure Survey • MOSTI (DOS) • MOA • MRRD • MDTCC • MOYS • Universities • Professional Bodies • NGOs 138 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 6. Establish smart Number of At least five research National Lead agency: partnership in research collaborative research projects by 2025 Universities with key stakeholders or projects carried out (Research research institutions Management Centre) Other agencies: • MOH • MOSTI • MOE • Professional Bodies 7. Establish the National The NIN established Institute established National Lead agency: Institute of Nutrition by 2025 MOH (NIN) Other agencies: • EPU • Universities 8. Update the Malaysian The Malaysian Food New Food Composition National Lead agency: Food Composition Composition Database Database to be MOH Database updated available by 2020 Other agencies: • Universities • Research institutes • Relevant agencies 139 National Plan of Action For Nutrition of Malaysia III, 2016-2025 140 National Plan of Action For Nutrition of Malaysia III, 2016-2025 FACILITATING STRATEGY To enable the identified activities in NPANM III to be effectively implemented, qualified and competent nutritionists and dietitians are crucial. The Allied Health Professions (AHP) Act will ensure that nutrition and dietetics are practised by appropriately trained professionals. This facilitating strategy focuses on activities that aim to ensure sufficient number of qualified professionals as well as their competencies. Some of these activities identified include registration of nutritionists and dietitians, periodic review of curriculum in universities, development of guideline to recognise subject matter experts (SME) and to provide more opportunities for post-graduate and sub-specialty training. Ensuring Sufficient Number of Qualified Nutritionists and Dietitians 4 141 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Periodic review of Number of curriculum Curriculum reviewed National Lead agency: nutrition & dietetic reviewed every five years MQA curriculum in universities Number of universities All universities with Other agencies: set by MQA nutrition & dietetic • MOH programmes by 2025 • Universities • Professional Bodies 2. Carry out registration of Number of registered All nutritionists and All levels Lead agency: nutrition and dietetics nutritionists and dietitians in MOH practitioners dietitians government sectors registered by 2017 Other agencies: • Universities At least 200 • Related nutritionists and ministries and dietitians in private agencies sectors registered • Industries by 2020 Number of registered 10 of trained nutrition nutritionists and professionals per dietitians per 100 000 population 100 000 population by 2025 3. Implement Code of Use of Code of Ethics All registered All levels Lead agency: Ethics and Professional and Professional nutritionists and MOH Conduct for nutritionists Conduct for dietitians comply with and dietitians nutritionists and the Code of Ethics by Other agencies: dietitians 2025 • Universities • Related ministries and agencies • Industries 4. Implement Continuing CPD achievement 100% of registered All levels Lead agency: Professional monitored nutritionists and MOH Development (CPD) as dietitians achieved a requirement to renew minimum CPD points Other agencies: practising certificate of 30 every two years • Universities • Related ministries and agencies • Industries 5. Develop Subject Matter Guidelines developed SME Guidelines National Lead agency: Expert (SME) Guidelines developed for MOH for Nutritionist and nutritionist and Dietitian dietitian in government Other agencies: sector by 2020 • JPA • Universities 142 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 6. Provide more Number of training Training needs National Lead agency: opportunities for post needs by specialised identified by 2018 MOH graduate, sub-speciality area identified training and cross- Other agencies: disciplinary training for Number of trained At least 10% of • JPA nutritionist and dietitian nutritionists and nutritionists and • Universities dietitians in dietitians in specialised area government sector trained in specialised area by 2025 143 National Plan of Action For Nutrition of Malaysia III, 2016-2025 144 National Plan of Action For Nutrition of Malaysia III, 2016-2025 FACILITATING STRATEGY To increase accessibility of nutrition information and services, a mandatory nutritionist placement in relevant ministries and agencies as well as industries is important. To further strengthen institutional and community capacity for nutrition, training on healthy eating, food safety and healthy meal preparation will need to be conducted to more trainers from other agencies. Strengthening Institutional and Community Capacity for Nutrition 5 145 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 1. Educate institutional Number of training At least one training National Lead agencies: child caregivers/ sessions session per year State • MOH operators on infant • JKM feeding based on: • JPM • Modul Latihan Pemakanan Bayi dan Other agencies: Kanak-Kanak • PPBM • Modul Latihan • All agencies Penilaian Taraf appointed by Pemakanan JKM 2. Train staff in registered Number of trainings At least one training National Lead agency: Childcare Centre based conducted per state per year State MOH on: • Modul Latihan Other agencies: Pemakanan Bayi dan • JPNIN Kanak-Kanak • JKM • Modul Latihan • PPBM Penilaian Taraf • NGOs Pemakanan 3. Conduct training on 4 in Number of TOT At least one training per National Lead agencies: 1 Module: Child Growth sessions year at national level State MOH Assessment and Infant Young Child Feeding Number of echo- At least one training Counselling Module training sessions per year at state level 4. Train health care Training conducted One training National Lead agency: providers on nutrition conducted per year MOH for children with special needs 5. Review nutrition Nutrition component Completed by 2020 National Lead agency: component in Early reviewed MOH Childhood Education Courses (Diploma/ Other agencies: Degree) • MOE • Universities 6. Train health staff and Number of training At least one training National Lead agency: institutional care conducted a year State MOH providers on nutritional management based on Other agencies: Modul Latihan • JKM Pemakanan Warga • Other related Emas di Institusi agencies 146 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 7. Expand the Number of new At least one new National Lead agency: implementation of agencies involved agency per year MOH nutrition training modules developed Other agencies: by Ministry of Health • MWFCD (MOH) • MRRD • MOA • MDTCC • MOYS • Other related ministries and agencies 8. Advocate more Number of nutritionists • At least one in National Lead agency: employment of in health and related each District Health MOH nutritionists in health facilities Office by 2020 and related facilities Other agency: • One in each JPA Health Clinic by 2025 9. Advocate employment Number of nutritionists At least one nutritionist National Lead agency: of nutritionists in in relevant ministries in selected ministries • JPA ministries and industries by 2025: • MOA dealing with food, • MOE • MOE nutrition and fitness: • MOA • MWFCD • MOE • MWFCD • MOYS • MOA • MOYS • MDTCC • MWFCD • MDTCC • MRRD • MOYS • MRRD • MDTCC • MRRD One nutritionist at Education District Office by 2025 10. Advocate more Number of dietitians in At least one dietitian National Lead agency: dietitians in hospitals each hospital per hospital by 2025 MOH Other agency: JPA 11. Strengthen nutrition Number of curriculum Review of nutrition National Lead agencies: component in the reviewed content every five • MOH training of other years • MOE professions in institutions; Other agency: • Medical Officers & MQA Paramedics • Nurses • Teachers (ERT & Physical Education) 147 National Plan of Action For Nutrition of Malaysia III, 2016-2025 No. Activity Output Indicator Target/ Time Frame (midterm,by year, by 2025) Implementation level Implementing agency 12. Implement nutrition Nutrition education Course on infant and National Lead agencies: education in the modules integrated in young child feeding • MOH E-Pembelajaran Sektor the E-Pembelajaran integrated into EPSA • INTAN Awam (EPSA) Sektor Awam (EPSA) by 2017 Course on Balanced Diet module integrated into EPSA by 2018 13. Carry out training on Number of training At least 2 training National Lead agency: the effective use of sessions conducted sessions per year State MOH Medical Nutrition (one hospital setting, Therapy (MNT) for all one clinic setting) Other agency: healthcare professionals Professional Bodies 14. Healthy Eating Healthy Eating course Healthy Eating course National Lead agency: course in the Ministry listed in the MOE listed as one of the MOE of Education (MOE) portal options in seven days Training Portal training for teachers Other agency: by 2018 MOH 148 National Plan of Action For Nutrition of Malaysia III, 2016-2025 Mechanism of Implementation, Monitoring and Evaluation of the NPANM III, 2016-2025 11.0 149 National Plan of Action For Nutrition of Malaysia III, 2016-2025 150 National Plan of Action For Nutrition of Malaysia III, 2016-2025 11.1 Implementation • The implementation of NPANM III, 2016-2025 activities at national level is through: Nutrition Division – This Division plays a leading role in implementing NPANM III, 2016-2025. Other Division in the Ministry of Health - Diseases Control Division (NCD), Health Education Division (HECC), Family Health Development Division (BPKK), Allied Health Sciences Division (BSKB), Development Division, Food Safety and Quality Division, Oral Health Development Division, Health Informatics Center, Nursing Division, Institute for Public Health, Institute of Medical Research, Malaysian Health Promotion Board (MySihat), to support the implementation of NPANM III, 2016 2025 activities. • The implementation of NPANM III activities at state/ district/ clinic level is coordinated by State Health Department. • Technical working groups are established to implement activities accordingly. There are 6 TWGs to support the implementation of NPANM; TWG Policy, TWG Training, TWG Research, TWG Promotion, TWG Dietary Guidelines, TWG Food & Nutrition Security (newly established). • Engagement with local government and communities in designing nutrition promotion/ intervention programmes. • Collaboration with private companies/ industries to address nutritional issues through Corporate Social Responsibility (CSR) activities. Implementation of NPANM III, 2016-2025 Activities Intra-Ministry (MOH) • National level - Various Divisions • State level - State Health Departments • District level - District Health Offices Inter-Ministries/ Agencies • Various ministries/ agencies • NGOs • Professional bodies • Universities • Private sectors especially food Industries Nutrition Technical Working Groups (6 TWGs) • TWG Policy • TWG Training • TWG Research • TWG Promotion • TWG Dietary Guidelines • TWG Food and Nutrition Security (Newly established) International Bodies • WHO • UN Agencies • Regional Office • ASEAN Sect. / Countries 151 National Plan of Action For Nutrition of Malaysia III, 2016-2025 11.2 Monitoring NFSNC (MKMPK) Report biennially NCCFN Report annually Activities in NPANM III, 2016-2025: • Intra-Ministry • TWGs • Inter-Ministries/ Agencies • International Bodies Monitored by • The National Food Safety and Nutrition Council (NFSNC) chaired by the Honourable Minister of Health Malaysia is the highest advisory Council to the government on issues related to food and nutrition. • Under the Council, there is a National Coordinating Committee for Food and Nutrition (NCCFN) chaired by Deputy Director General of Health (Public Health). Members of this committee consist of senior officers from various ministries and agencies, universities, professional bodies and NGOs. This committee has an overall purview to monitor and evaluate the implementation of the Plan. • Currently, there are five (5) Technical Working Groups (TWGs) for Nutrition under the NCCFN which are TWG Policy, TWG Guidelines, TWG Training, TWG Research and TWG Promotion. In addition, TWG for Food and Nutrition Security co-chaired by Ministry of Health and Ministry of Agriculture and Agro-based Industry will be established to look at the issues on Food and Nutrition Security. • Annual monitoring will be carried out to monitor the progress and achievements in the identified activities. 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WHO/International Association for the Study of Obesity/International Obesity Task Force (2000): The Asia-Pacific Perspective: Redefining Obesity and itsTreatment. – IOTF,Health CommunicationsAustralia Pty Ltd., Brisbane. 154 National Plan of Action For Nutrition of Malaysia III, 2016-2025 Appendices 155 National Plan of Action For Nutrition of Malaysia III, 2016-2025 156 National Plan of Action For Nutrition of Malaysia III, 2016-2025 Chairman Datuk Dr. Lokman Hakim bin Sulaiman Deputy Director General of Health (Public Health) Members • Nutrition Division, MOH Puan Rokiah Don Puan Zalma Abdul Razak Cik Rusidah Selamat Puan Zaiton Daud Puan Norhaizan Mustapha Encik Nazli Suhardi Ibrahim Puan Nor Azliana Mohamat Nor Puan Siti Shuhailah Shaikh Abd Rahim Puan Noriza Zakaria Puan Rashadiba Ibrahim @ Rahman Puan Khairul Zarina Mohd Yusop Puan Fatimah Zurina Mohamad Puan Junidah Raib Encik Mohamad Soffian Mohamad Rasid Puan Norlida Zulkafly Cik Gui Shir Ley Cik Teh Wai Siew Puan Ainan Nasrina Ismail Encik Ng Chee Kai Puan Siti Adibah Ab. Halim Puan Rozalina Ismail Puan Wan Fazlily Wan Mahmod Puan Wong Hui Juan Puan Nur Liana Abdul Latiff Puan Tan Yen Nee Puan Intan Hartini Ahmad Bidin Encik Mohd Hasyami Saihun Cik Nur Azlina Abd. Aziz Cik Norashikin Ramlan Encik Azwan Kamaruddin Puan Norfahimah Mohd Norddin Puan Nor Shafawati Mohd Ghazali Cik Zamilah Hasniah Abdul Hamid Puan Akmar Zuraini Daud Puan Noor Faezah Abdul Jalil Puan W. Nurul Ashikin W. Mohamad Puan Siti Fatimah Sa'at • Family Health Development Division, MOH Dr. Nik Rubiah Nik Abdul Rasid Dr. Aminah Bee Mohd Kassim Dr. Noorhaire Sumarlie Nordin Dr. Tuty Adrizan Irdawati Mohsinon Puan Mahawa Abdul Manan Encik Abdul Shukor Salha • Disease Control Division, MOH Dr. Feisul Idzwan Mustapha Encik Azhar Yusuf Puan Siti Farah Zaidah Mohd Yazid • Health Education Division, MOH Encik Munshi Abdullah Puan Ruffina Dalis Jimen Cik Norlaily Md Nasir • Food Safety and Quality Division, MOH Puan Nik Shabnam Nik Mohd Salleh Puan Norliza Zainal Abidin Puan Laila Muhammad • Allied Health Sciences Division, MOH Puan Farina Zulkernain • Policy & International Relations Division, MOH Cik Norbee Abdul Hamid THE NPANM III, 2016-2025 DRAFTING COMMITTEE • Development Division, MOH Dr. Mahani Binti Ahmad Hamidy • Oral Health Development, MOH Dr. Nur Athirah Imran • Health Informatics Center, MOH Puan Elizabeth Joseph • Nursing Department, MOH Puan Jamizah Zuki Puan Gowry a/p Narayanan • Institute for Public Health, MOH Dr. Tahir Aris Encik Ahmad Ali Zainuddin Encik Hasnan Ahmad • Institute of Medical Research, MOH Cik Norhayati Mustafa Khalid Puan Noraini Mustafa • Malaysian Health Promotion Board (MySihat) Puan Noorul Izdiany Mokhtar • Hospital Kuala Lumpur Dr. Noor Haliza Yusoff Tn. Hj. Ridzoni Sulaiman Encik Rosli Mohd Sali • Johor State Health Department Encik Yahya Ahmad • Sarawak State Health Department Puan Bong Mee Wan • Negeri Sembilan State Health Department Puan Fatimah Sulong • Selangor State Health Department Encik Ja’afar Mohamed Idris • Melaka State Health Department Puan Jamilah Ahmad • Kedah State Health Department Puan Suriana Johari • Pulau Pinang State Health Department Puan Siti Rohana Din Puan Zuhaida Harun • Perak State Health Department Puan Zuraini Abdullah • Pahang State Health Department Puan Noor Afiza Ibrahim • Kelantan State Health Department Puan Puspawati Mohamed • Sabah State Health Department Cik Rafidah Yusof • Wilayah Persekutuan Kuala Lumpur & Putrajaya State Health Department Puan Nor Azah Ahmad Puan Mariati Muslim • Wilayah Persekutuan Labuan State Health Department Puan Ho Shu Fen • Petaling District Health Office Puan Siti Mariam Ali • Besut District Health Office Puan Norhaniza Rojalai • Ministry of Education Encik Noor Azizan Abd. Hadi Puan Mas Yanti Ghazali Cik Tan Huey Ning Encik Hisamudin Mohd Tamim Encik Muhammad Zamri Awang Puan Ilminza Zakaria • Ministry of Rural and Regional Development Puan Norazah Abdul Shukor Tuan Haji Ahmad Sulaiman Puan Aainaa Mastura Abu Bakar 157 National Plan of Action For Nutrition of Malaysia III, 2016-2025 • Ministry of Agriculture and Agro-based Industry Encik Nordanial Rohimi Encik Ahmad Fauzi Idris Puan Roziah Abudin Encik Mohd Ramesh Krishna Cik Vaani Munianely • Ministry of Science, Technology and Innovation Puan Intan Maslina Ngaimon • Ministry of Women, Family and Community Development Cik Connie Remong Puan Norhayati Abdul Razak Puan Fazilah Abdul Rahman • Ministry of Urban Wellbeing, Housing and Local Government Tuan Haji Suhaili Haji Sirun Encik Zulkifli Mohammad Encik Mohamed Ali Othman • Ministry of Youth and Sport Encik Ahmad Huzairi Rawee Encik Ahmad Syarifudin • Ministry of Domestic Trade, Co-operatives and Consumerism Puan Marlina Ramly Puan Nuraznida Abdul Halyily • Ministry of Communications and Multimedia Puan Farahdila Wati Mohd Khamdee • National Sports Institute Puan Chai Wen Jin • Prime Minister’s Department Tuan Haji Al-Arif Abdul Rahim • Public Service Department Puan Noor Azilah Abu Shahid • National Service Program Department Encik Muhamad Hanif Hasman Yusri Encik Suresh Ramasamu • National Unity and Integration Department Puan Hamidah Abu Bakar • Department of Orang Asli Development Encik Khairul Anuar Che Zakaria Encik Mazlee Maskin • Malaysian Investment Development Authority (MIDA) Puan Wan Supiyati Wan Abdullah Encik Fauzul Hamizah Mohd Zulkifli • Federal Agriculture Marketing Authority (FAMA) Puan Aiada Abdul Rashid • Malaysian Agricultural Research and Development Institute (MARDI) Puan Umi Kalsum Hussain Zaki • Taylor’s University Prof. Emeritus Dr. Mohd. Ismail Noor • Universiti Kebangsaan Malaysia (UKM) Prof. Dr. Aminah Abdullah Prof. Dr. Norimah Ab Karim Prof. Dr. Poh Bee Koon • Universiti Teknologi MARA (UiTM) Prof Madya Datin Dr. Safiah Mohd Yusof Prof Madya. Dr Mahendran Appukutty • Universiti Putra Malaysia (UPM) Prof. Emeritus Dr Khor Geok Lin Prof. Dr Zalilah Mohd Shariff Prof. Dr. Loh Su Peng • Universiti Malaysia Sarawak (UMS) Puan Zainab Tambi • Universiti Sains Malaysia (USM) Dr. Foo Leng Huat National Plan of Action For Nutrition of Malaysia III, 2016-2025 158 National Plan of Action For Nutrition of Malaysia III, 2016-2025 159 • Universiti Malaysia Sabah (UMS) Dr Yasmin Ooi • Universiti Islam Antarabangsa Malaysia (UIA) Dr Wan Azdie Mohamad Abu Bakar • Nutrition Society of Malaysia (NSM) Prof. Dr. Tee E Siong • Malaysian Dietitian Associations (MDA) Dr. Zulfitri Azuan Mat Daud • National Diabetes Institute (NADI) Ms Choo Su Huang • Majlis Cegah Obesiti Malaysia (MCOM) Encik Jong Koi Chong • Malaysian Society of Hypertension (MSH) Prof Datin Dr. Chia Yook Chin • National Cancer Society of Malaysia Cik Chan Wan Thung • Persatuan Penasihat dan Pakar Laktasi Malaysia (PPPLM) YBhg. Dato’ Dr. Zuraidah Abdul Latiff • Malaysian Breastfeeding Peer Counsellor Association (MBfPCA) Puan Nor Kamariah Mohd Alwi • Associated of Registered Childcare Providers of Malaysia (PPBM) Datin P.H. Wong Encik Hashim Ibrahim Puan Norhayati Karno • Klang Healthy Lifestyle Promotion Association Puan Surainee Wahab • TADIKA Association Malaysia Puan Lina Yeok Gaik Li • Majlis Pengetua Sekolah Malaysia Puan Faridah Abd Gani • Majlis Guru Besar Kebangsaan Encik Mas’ood Idris • Federation of Malaysia Manufacturers (FMM) Dato’ Dr. Neoh Soon Encik Ng Kim Keat Puan Hasreena Hshim Puan Megawati Suzany • SME Corporation Malaysia Puan Noor Azura Hasran 160 National Plan of Action For Nutrition of Malaysia III, 2016-2025 Advisors Datuk Dr. Lokman Hakim bin Sulaiman Deputy Director General of Health (Public Health) Members • Nutrition Division, MOH Puan Rokiah Don Puan Zalma Abdul Razak Cik Rusidah Selamat Puan Zaiton Daud Puan Norhaizan Mustapha Encik Nazli Suhardi Ibrahim Puan Nor Azliana Mohamat Nor Puan Siti Shuhailah Shaikh Abd Rahim Puan Noriza Zakaria Puan Rashadiba Ibrahim@Rahman Puan Khairul Zarina Mohd Yusop Puan Fatimah Zurina Mohamad Puan Junidah Raib Puan Ainan Nasrina Ismail Encik Mohamad Soffian Mohamad Rasid Puan Rozalina Ismail Puan Nor Hanisah Zaini Puan Akmar Zuraini Daud • Family Health Development Division, MOH Dr. Nik Rubiah Nik Abdul Rasid Dr. Aminah Bee Mohd Kassim • Disease Control Division, MOH Encik Azhar Yusuf • Health Education Division, MOH Puan Ruffina Dalis Jimen • Food Safety and Quality Division, MOH Puan Nik Shabnam Nik Mohd Salleh Puan Norliza Zainal Abidin • Allied Health Sciences Division, MOH Puan Farina Zulkernain • Development Division, MOH Dr. Mahani Binti Ahmad Hamidy • Institute for Public Health, MOH Dr. Tahir Aris Encik Ahmad Ali Zainuddin Encik Hasnan Ahmad • Melaka State Health Department Puan Jamilah Ahmad • Wilayah Persekutuan Kuala Lumpur & Putrajaya State Health Department Puan Nor Azah Ahmad • Ministry of Agriculture and Agro-based Industry Encik Mohd Ramesh Krishna • Nutrition Society of Malaysia (NSM) Prof. Dr. Tee E Siong • Taylor’s University Prof. Emeritus Dr. Mohd. Ismail Noor • Universiti Kebangsaan Malaysia (UKM) Prof. Dr. Norimah Ab Karim • Universiti Teknologi MARA (UiTM) Prof. Madya Datin Dr. Safiah Mohd Yusof • Universiti Putra Malaysia (UPM) Prof. Emeritus Dr Khor Geok Lin Prof. Dr Zalilah Mohd Shariff THE NPANM III, 2016-2025 EDITORIAL COMMITTEE ABBREVIATIONS ADA American DiabetesAssociation APHM Association of Private Hospitals of Malaysia (Persatuan Hospital-Hospital Swasta Malaysia) APM Angkatan PertahananAwam (Malaysian Civil Defence Force) ASM Akademi Sains Malaysia (Academy of Sciences Malaysia) CAM Chefs Association of Malaysia (Persatuan Jurumasak Malaysia) CUEPACS Congress of Union of Employees in the Public and Civil Services (Kongres Kesatuan Pekerja-Pekerja di Dalam PerkhidmatanAwam) DOA Department of Agriculture (Jabatan Pertanian) DOS Department of Statistics (Jabatan Statistik) EPU Economic Planning Unit (Unit Perancang Ekonomi) F&B Food & Beverages Industries (Industri Makanan & Minuman) FAMA Federal Agriculture MarketingAuthority (Lembaga Pemasaran Pertanian Persekutuan) FMM Federation of Malaysia Manufacturers (Persekutuan Pekilang-Pekilang Malaysia) FOMCA Federation of Malaysia ConsumerAssociation (Gabungan Persatuan-Persatuan Pengguna Malaysia) 161 National Plan of Action For Nutrition of Malaysia III, 2016-2025 IBFAN International Baby FoodAction Network IKU Institut Kesihatan Umum (Institute for Public Health) IMR Institute of Medical Research (Institut Penyelidikan Perubatan) INTAN Institut TadbiranAwam Negara (National Institute of Public Administration) IOM Institute of Medicine IPGM Institut Perguruan Malaysia (Institute of Teacher Education) JAKIM Jabatan Kemajuan Islam Malaysia (Department of Islamic Development) JAKOA Jabatan Kemajuan OrangAsli (Department of OrangAsli Development) JKM Jabatan Kebajikan Masyarakat (Department of SocialWelfare) JLKN Jabatan Latihan Khidmat Negara (National Service Training Programme Department) JPA Jabatan PerkhidmatanAwam (Public Service Department) JPM Jabatan Perdana Menteri (Prime Minister’s Department) JPNIN Jabatan Perpaduan Negara dan Integrasi Nasional (Department of National Unity and Integration) KEMAS Jabatan Kemajuan Masyarakat (Community Development Department) LPPKN Lembaga Penduduk dan Pembangunan Keluarga Negara Malaysia (National Population and Family Development Board) MAMPU MalaysianAdministrative Modernisation and Management Planning Unit (Unit Pemodenan Tadbiran dan Perancangan Pengurusan Malaysia) MARDI MalaysianAgricultural Research and Development Institute (Institut Penyelidikan dan Kemajuan Pertanian Malaysia) MASO MalaysianAssociation for the Study Obesity (Persatuan Kajian Obesiti Malaysia) 162 National Plan of Action For Nutrition of Malaysia III, 2016-2025 163 National Plan of Action For Nutrition of Malaysia III, 2016-2025 MBfPCA Malaysian Breastfeeding Peer Counsellor Association (Persatuan Kaunselor Penyusuan Susu Ibu Malaysia) MCMM Ministry of Communications and Multimedia (Kementerian Komunikasi and Multimedia) MCMC Malaysian Communications and Multimedia Commission (Suruhanjaya Komunikasi dan Multimedia Malaysia) MDA Malaysian Dietitians’ Association (Persatuan Dietitian Malaysia) MDTCC Ministry of Domestic Trade, Co-operatives and Consumerism (Kementerian Perdagangan Dalam Negeri, Koperasi dan Kepenggunaan) MJSC MARA Junior Science College (Maktab Rendah Sains MARA) MUWHLG Ministry of UrbanWellbeing, Housing and Local Government (Kementerian Kesejahteraan Bandar, Perumahan dan Kerajaan Tempatan) MIDA Malaysian Investment DevelopmentAuthority (Lembaga Pembangunan Pelaburan Malaysia) MINDEF Ministry of Defence (Kementerian Pertahanan) MKN Majlis Keselamatan Negara (National Security Council) AGC Attorney General’s Chambers (Jabatan Peguam Negara) MOA Ministry of Agriculture andAgro-based Industry (Kementerian Pertanian dan Industri Asas Tani) MOE Ministry of Education (Kementerian Pendidikan Malaysia) MOF Ministry of Finance (Kementerian Kewangan Malaysia) MOH Ministry of Health (Kementerian Kesihatan Malaysia) MOHA Ministry of HomeAffairs (Kementerian Dalam Negeri) MOHR Minsitry of Human Resources (Kementerian Sumber Manusia) MOSTI Ministry of Science,Technology and Innovation (Kementerian Sains,Teknologi dan Inovasi) MOT Ministry of Transport (Kementerian Pengangkutan) MOTAC Ministry of Tourism and Culture (Kementerian Pelancongan dan Kebudayaan) MOYS Ministry of Youth and Sport (Kementerian Belia dan Sukan) MOHE Ministry of Higher Education (Kementerian Pengajian Tinggi) MPIC Ministry of Plantation Industries and Commodities (Kementerian Perusahaan Perladangan dan Komoditi) MQA Malaysian QualificationsAgencies (Agensi Kelayakan Malaysia) MRRD Ministry of Rural and Regional Development (Kementerian Kemajuan Luar Bandar danWilayah) MTUC Malaysian Trades Union Congress (Kongres Kesatuan Sekerja Malaysia) MWFCD Ministry ofWomen, Family and Community Development (Kementerian PembangunanWanita, Keluarga dan Masyarakat) NCCFN National Coordinating Committee on Food and Nutrition (Jawatankuasa Penyelaras Kebangsaan untuk Makanan dan Pemakanan) NGO Non-Government Organizations (Pertubuhan Bukan Kerajaan) NDPC National Development Planning Commission (Jawatankuasa Perancang Pembangunan Negara) NIH National Institute of Health Secretariat (Sekretariat Institut Kesihatan Kebangsaan) NSFNC National Food Safety and Nutrition Council (Majlis Keselamatan Makanan dan Pemakanan Kebangsaan (MKMPK)) NSM Nutrition Society of Malaysia (Persatuan Pemakanan Malaysia) NUTP National Union of the Teaching Profession Malaysia (Kesatuan Perkhidmatan Perguruan Kebangsaan Malaysia) 164 National Plan of Action For Nutrition of Malaysia III, 2016-2025 PPBM Persatuan Pengasuh Berdaftar Malaysia (Associated of Registered Childcare Providers of Malaysia) PPPIM Persatuan Penggalak Penyusuan Susu Ibu Malaysia PPPLM Malaysian LactationAdvises and Consultant Association (Persatuan Penasihat dan Pakar Laktasi Malaysia) PTA Parent Teacher Association (Persatuan Ibubapa dan Guru) PUSPANITA Persatuan Suri danAnggota PerkhidmatanAwam Malaysia SHD State Health Department (Jabatan Kesihatan Negeri) SMAN Sekolah MenengahAgama Negeri SMAR Sekolah MenengahAgama Rakyat SME Small Medium Enterprises (Perusahaan Kecil dan Sederhana) SSM Suruhanjaya Syarikat Malaysia (Companies Commission of Malaysia) PPKM Persatuan Pengurusan Kompleks Malaysia (Malaysia Shopping Malls Association) PDK Pusat Pemulihan Dalam Komuniti (Community-based Rehabilitation Center) UN United Nations (Bangsa-Bangsa Bersatu) UNICEF United Nations Children’s Funds UPM Universiti Putra Malaysia WHO World Health Organizations (Pertubuhan Kesihatan Sedunia) 165 National Plan of Action For Nutrition of Malaysia III, 2016-2025 http://nutrition.moh.gov.my Nutrition Division Level 1, Block E3, Complex E, Precinct 1, Federal Government Administration Office, 62590 Putrajaya, Malaysia. Tel: 03-8892 4503 • Fax: 03-8892 4511 ISBN 978-967-0769-64-6 9 7 8 9 6 7 0 7 6 9 6 4 6