Nutrition and Dietetics

Dietetics is the science of how food and nutrition affect human health. Practising healthy eating habits in line with proper nutrition is crucial in preventing a wide range of non-communicable diseases such as obesity, diabetes mellitus and hypertension.

Over the years, we have witnessed a shift in dietary patterns due to change in lifestyle and rapid urbanisation. Coupled with the fact that people are consuming food with less dietary fibre and high sugars and fats, it is no surprise that obesity has seen a worrying increasing trend.

Nutrition and health FAQ

1. What is healthy eating?

Healthy eating is all about consuming food to fulfil your daily nutritional requirements while consciously avoiding factors that can contribute to diet-related diseases.

To simplify this concept, the Ministry of Health Malaysia (MOH) has introduced “healthy plate” (pinggan sihat Malaysia)⁹ which serves as a visual model for meal-planning on a daily basis.

The healthy plate was designed based on a 10-inch plate which is the standard use for most Malaysians. The idea behind this is to consume a quarter-plate of whole grain carbohydrates, a quarter-plate of protein and a half-plate full of dietary fibres such as fruits and vegetables.

Through this illustration, we are encouraged to take proportionate amounts of macronutrients. This concept emphasises the need to include all aspects of macronutrients and micronutrients to optimise health and increase immune system strength to fight off diseases.

2. Why is healthy eating important?

According to the World Health Organization (WHO), the prevalence of obesity in 2016 has tripled since 1975¹, with over 1.9 billion adults categorised as being overweight and obese.

This is a major cause for concern as obesity is largely accordionn-titleed with a multitude of chronic diseases such as diabetes mellitus and hypertension, to name a few.

In 2019, the National Health and Morbidity Survey (NHMS) found that around 51% of Malaysians were either overweight or obese compared to 48% in 2015². Malaysia also has the highest prevalence of obesity in Southeast Asia³, implying the urgency of intervention programmes to curb the problem.

Healthy eating is viewed as one of the solutions that can drastically reduce the risk of developing diet-related diseases. It can improve various aspects of life ranging from brain function to physical performance.

Diabetes mellitus, hypertension and heart diseases are all closely related to individual lifestyle choices. Various studies have shown that the risk of diabetes progression is reduced with dietary changes, an increase in physical activity and healthy weight loss^6,7,8, thus signifying the importance of adopting a healthy lifestyle.

3. What is BMI and why is it important?

In 1993, WHO recommended the use of body mass index (BMI) to stratify risks of contracting non-communicable diseases.

It can be calculated as weight in kilograms (kg) which is divided by height in meters (m) squared (kg/m²) and should be used in combination with other risk factors to estimate individual morbidity and mortality risk.

For example, if you weight 60 kg and are 1.65 m tall, your BMI can be calculated as below:

60 kg ÷ 1.65 m ÷ 1.65 m = 22.04 kg m²

Although BMI was intended to be used on an international scale, the incidence of certain diseases such as diabetes varied among ethnic groups. In addition, Asians carry more body fat which imposes a much greater risk of developing cardiovascular diseases compared to other populations.

In 2002, a new class of BMI was introduced for Asian-specific populations as described below:

BMI	Nutritional status
Below 18.5	Underweight
18.5 - 22.9	Normal weight
23.0 - 27.4	Pre-obesity/Overweight
27.5 - 32.4	Obesity class I
32.5 - 37.4	Obesity class II
Above 37.5	Obesity class III

Table 1: Body Mass Index for Asian populations

4. What is the right nutritional proportion for a healthy diet?

According to the MOH, the distribution of macronutrients to satisfy the daily energy needs of Malaysia's adult population should be as follows:

Macronutrients	Recommended Amount (%)
Carbohydrates	50-65
Fats	25-30
Proteins	10-20

Table 2: Recommended macronutrient proportion¹⁴

This recommendation was made based on various factors that can affect the total energy requirement such as age, gender, and the difference between individual and population variations in basal metabolic rate (BMR).

People who practice certain types of diet plans for weight loss may require different percentages for macronutrient proportion. For example, those who practice a ketogenic diet would have lower carbohydrate and higher fat distribution.

Some evidences have showed positive result in weight loss and some health parameter for this particular diet in the short term. However, this particular practice is not recommended due to its poor long-term sustainability.

It has been suggested that long-term ketogenic diet may increase risk of kidney stones and osteoporosis, and uric acid level (a risk factor for gout). It may also cause lacking in nutrients if a variety of recommended foods on the ketogenic diet are not included.

A well-balanced diet following healthy plate model should be able to satisfy your daily energy requirement while preventing diet-related diseases. The consumption of free sugar, or sugar that is found in cooked food, should be kept below 5% of the total energy intake to achieve additional health benefits¹⁵.

5. Why do I need to increase my fibre intake?

There isn’t a single type of food that can provide all of the nutrients required to live healthily. Each type has its own merit.

For instance, rice contains carbohydrates while chicken and avocado are rich in protein and dietary fat respectively. Among all of these different types of food available, fibre is one that most Malaysians tend to take for granted¹⁶.

Even though most of us realise the importance of consuming dietary fibre, only a few are aware of how much is needed per day¹⁰.

The Malaysian Dietary Guidelines (MDG) recommend two daily servings of fruits and three daily servings of vegetables¹¹.

However, a study conducted by Healthy Eating and Lifestyle Practices Association (HELP) and Khazanah Research Institute in 2019 has found that the recommended dietary fibre intake by MDG is in fact lower than the amount required¹².

Both types of fibre, soluble and insoluble, are important in maintaining good health. Advocating high fibre intake can help you stay clear of obesity¹³ and high cholesterol.

Furthermore, foods that have high fibre content usually contain antioxidants that can combat the effects of free radicals, which are associated with ageing, inflammation, and degenerative diseases such as Parkinson’s and Huntington’s diseases.

6. How much water intake is required to keep the body healthy?

According to the Malaysian Dietary Guidelines 2011, Malaysians should drink 6 to 8 glasses of plain water daily. An increase of up to 2 glasses daily is recommended due to temperature and level of activities.

Following are the benefits of drinking water:

Helps to remove waste through urine, stools, and sweat
Helps to maintain normal body temperature
Protects internal body tissues
Maintains the lubrication and cushioning of joints

7. Are dietary supplements important?

Dietary supplements include vitamins, minerals, amino acids, enzymes, hormonal supplements, etc.

Most dietary supplements are sold as tablets, capsules, liquids, or powders. Dietary supplements help to balance the deficiency of nutrients and reduce the risk of certain diseases.

However, supplements should not be considered as a replacement for a complete and balanced meal.

Some supplements that contain active ingredients may have side effects and cause complications to health. Additionally, actions like combining supplements (without a doctor’s advice), using certain supplements with medicines, substituting them for medicinal prescriptions, and taking too much of some supplements may cause more harm than benefit.

It is recommended to talk to your healthcare provider before starting on any supplements.

8. Do I need to go for regular health check-ups?

Yes. Health screenings are medical tests that doctors conduct/advise to check for diseases, deficiencies present in an individual.

Various diseases can be prevented by timely intervention and lifestyle changes through proper diet, supplements, etc.

Health screenings can help people discover what is required to be done to prevent the development of certain conditions in their bodies. Consuming a healthy and well-balanced diet, consulting a dietitian, maintaining exercise routines, therapies to manage stress levels, taking nutritional supplements, etc may help prevent certain high-risk diseases in individuals.

Reach out to us at Pantai Hospitals Malaysia for a health screening package that is appropriate for you.

9. What are diet plans and how do I find a suitable one?

Weight loss plans are recommended for people who are overweight or obese.

However, there are many conflicting options on the web which may make one feel overwhelmed.

It is recommended to talk to your doctor before picking up a weight loss program. Your doctor or dietitian will review your medical health conditions, current medications, BMI, diet history, and other factors in order to create a plan suitable to your needs.

They will also be able to recommend exercise routines that you may start.

10. What are the essentials of healthy weight loss?

While different tips are available for different weight loss plans, the following are some essential tips to remember: