Nutritional Status and Dietary Patterns Among School Children in Selected Malaysian Primary Schools

Published: Malaysian Journal of Public Health Medicine, 2005; Vol. 5(2): 58–63

Original URL: MJPHM Volume 5, Issue 2, 2005

Last reviewed: March 2026

Background: Malaysia’s Nutritional Transition

By the mid-2000s, Malaysia was deep in the throes of what nutritional epidemiologists term the “nutrition transition” — the population-level shift from diets characterised by staple grains, legumes, and vegetables to diets increasingly dominated by refined carbohydrates, added sugars, animal fats, and processed foods. This transition, driven by rapid economic development, urbanisation, and globalisation of food systems, had profound implications for the nutritional status of children, who were simultaneously exposed to both the residual effects of undernutrition and the emerging epidemic of overnutrition.

Malaysia’s nutrition transition was occurring at a particularly rapid pace compared with many other developing countries, reflecting the country’s swift economic growth during the 1990s and 2000s. The proliferation of fast food restaurants, convenience stores, and processed food options in urban and increasingly in semi-urban areas provided children with easy access to energy-dense, nutrient-poor foods. At the same time, traditional dietary patterns — centred on rice, fish, vegetables, and coconut — were being progressively displaced, particularly among younger generations.

This nutritional landscape had direct implications for child health outcomes. The dual burden of malnutrition — the coexistence of undernutrition and overnutrition within the same population, community, or even household — was becoming an increasingly recognised public health challenge in Malaysia. Understanding the dietary patterns, nutritional status, and determinants of nutritional outcomes among school-age children was essential for developing targeted interventions.

Nutritional Status of Malaysian School Children

Surveys conducted in Malaysian primary schools during the mid-2000s painted a complex picture of children’s nutritional status. Using the World Health Organization (WHO) growth reference standards, the prevalence of underweight (low weight-for-age), stunting (low height-for-age), and thinness (low BMI-for-age) among Malaysian school children had declined substantially from the rates observed in the 1980s and 1990s, reflecting improvements in overall food security, healthcare access, and living standards. However, these conditions had not been eliminated, particularly among lower-income households, rural communities, and indigenous (Orang Asli) populations.

Simultaneously, the prevalence of overweight and obesity among school children was increasing at an alarming rate. By the mid-2000s, studies were reporting overweight and obesity rates of approximately 20–30% in urban primary school populations, with higher rates observed in certain states such as Selangor, Johor, and the Federal Territory of Kuala Lumpur. These figures placed Malaysian children among the most overweight in the ASEAN region.

Dietary Patterns and Food Consumption

Breakfast Habits

The breakfast skipping phenomenon was well documented among Malaysian school children. Studies from this period consistently reported that approximately 20–30% of primary school children regularly skipped breakfast, with rates slightly higher among children from lower-income households and among boys compared with girls. Common reasons for breakfast skipping included lack of time in the morning, lack of appetite, and unavailability of breakfast food at home. Children who skipped breakfast showed lower overall nutrient intake, poorer concentration in school, and in some studies, higher rates of overweight — possibly due to compensatory overeating later in the day.

Sugar-Sweetened Beverage Consumption

The consumption of sugar-sweetened beverages (SSBs) was widespread among Malaysian children. Tea with condensed milk (teh tarik), flavoured soy drinks, carbonated beverages, and commercial fruit-flavoured drinks were consumed frequently. Studies documented that children were consuming an average of one to two servings of SSBs daily, contributing significant amounts of added sugar to their diets without meaningful nutritional benefit. The availability and low cost of these beverages, combined with a cultural preference for sweet drinks, made this a particularly challenging dietary behaviour to modify.

Snacking Patterns

School canteens and surrounding food vendors provided the primary environment for children’s snacking behaviour during school hours. Audits of foods available at school canteens revealed a predominance of fried foods, processed snacks, confectionery, and sweetened drinks, with relatively limited availability of fruits, vegetables, and healthier options. While the Ministry of Health and Ministry of Education had issued guidelines for healthy food provision in schools, enforcement and compliance were variable.

Fruit and Vegetable Intake

Fruit and vegetable consumption among Malaysian school children was consistently below recommended levels. Studies from this period reported that fewer than 20% of children consumed the WHO-recommended five servings of fruits and vegetables daily. Barriers to adequate fruit and vegetable consumption included children’s taste preferences, the relatively higher cost of fresh produce compared with processed alternatives, limited variety of preparation methods that appealed to young palates, and the influence of advertising for competing food products.

Determinants of Nutritional Status

Multivariate analyses identified several key determinants of nutritional outcomes among Malaysian school children. Household socioeconomic status, typically measured through parental income and education, was the most consistently significant factor. Children from wealthier households had better access to diverse, nutritious foods and were less likely to be underweight, though they were also more likely to be overweight, reflecting the paradox of the nutrition transition.

Parental education, particularly maternal education, showed a strong association with children’s dietary quality. Mothers with higher education levels were more likely to prepare balanced meals, limit junk food consumption, and encourage breakfast eating. Conversely, in households where both parents worked long hours, children were more likely to be left to make their own food choices, which tended to favour convenience and processed options.

Physical activity levels also contributed to the nutritional status equation. By the mid-2000s, Malaysian children were spending increasing amounts of time in sedentary activities, including watching television, playing video games, and later, using computers and mobile devices. Reduced opportunities for outdoor play, particularly in urban areas where green spaces were limited and safety concerns restricted unsupervised outdoor activity, contributed to an energy imbalance that favoured weight gain.

School-Based Nutrition Interventions

Recognising the school setting as a critical venue for nutrition intervention, the Malaysian government implemented several programmes. The School Supplementary Feeding Programme (Program Rancangan Makanan Tambahan, or RMT) provided nutritious meals to children from low-income families, addressing immediate nutritional needs while also serving as an incentive for school attendance. The National School Milk Programme provided free milk to primary school students.

Health education components within the school curriculum addressed basic nutrition principles, the importance of balanced diets, and the benefits of physical activity. However, evaluations of these programmes suggested that knowledge transfer alone was insufficient to change dietary behaviour, and that environmental modifications — such as improving the nutritional quality of school canteen offerings and restricting the sale of unhealthy food within and near school premises — were likely to be more impactful.

Long-Term Health Implications

The nutritional patterns observed among Malaysian children in the mid-2000s carried significant long-term health implications. Childhood overweight and obesity track strongly into adulthood, and the metabolic consequences — including insulin resistance, dyslipidaemia, and elevated blood pressure — can begin during childhood itself. The rising prevalence of childhood obesity during this period foreshadowed the escalating burden of type 2 diabetes, cardiovascular disease, and other non-communicable diseases that Malaysia would face in subsequent decades.

Limitations

Studies of childhood nutritional status from this period shared several common limitations. Anthropometric measurements, while objective, provide only indirect information about body composition and do not capture visceral adiposity or metabolic health directly. Dietary assessment methods, particularly 24-hour recalls and food frequency questionnaires administered to young children, are subject to significant recall bias and may not accurately reflect habitual intake. Most studies were cross-sectional, preventing the establishment of causal relationships. The sampling was often confined to selected schools or districts, limiting the generalisability of findings to the broader Malaysian child population.