Citation
Miow, Yee Xuen
(2024)
Development of local food-based recommendations using linear programming for undernourished urban poor children from KEMAS preschools in Seremban, Malaysia.
Doctoral thesis, Universiti Putra Malaysia.
Abstract
Childhood undernutrition can lead to lifelong poor health, limited opportunities, and
reduced economic productivity. In Malaysia, undernutrition among children under
five years old remains a serious public health concern, especially in urban poor
populations. Thus, this study aimed to develop local food-based recommendations
(FBRs) based on current food consumption patterns that could achieve dietary
adequacy and meet average food cost for undernourished urban poor children aged
two to five years by using Linear Programming (LP) approach. This cross-sectional
study involved 168 undernourished preschoolers from 35 randomly selected KEMAS
preschools in Seremban, Negeri Sembilan. Anthropometric measurements (weight
and height) were measured to identify undernourished children. Mothers completed
an online self-administered questionnaire on socio-demographic characteristics and
food security and dietary intake data were assessed through three-day 24-hour dietary
recalls via online interview. Dietary diversity and diet quality were measured using
dietary diversity score and Standardised Malaysian Healthy Eating Index (S-MHEI), respectively. Daily dietary costs were determined using the food price data obtained
from the Ministry of Domestic Trade and Consumer Affairs and market surveys and
FBRs were developed using WHO Optifood software version 4.0.14.0, employing an
LP approach to optimise dietary intake.
The mean weight-for-age z-score (WAZ), height-for-age z-score (HAZ), and weight-
for-height z-score (WHZ) of all the undernourished urban poor children were -1.58 ±
0.56, -1.45 ± 0.89, and -0.99 ± 1.22, respectively. With most meals prepared by
schools, the overall dietary diversity score was 6.20 ± 0.51 out of 9. The overall diet
quality score was 88.71 ± 4.94 out of 100. The average daily dietary cost was RM
10.20 ± 3.24. Results of this study found that for children aged two to three years,
folate and zinc were identified as partial problem nutrients [a nutrient for which the
requirement (%RNI) cannot be met in the two best diets, but 100% of the RNI can be
met in the highest achievable level for that nutrient in the maximised diet] after
adjusting food portion sizes according to national recommendations. The final FBRs
for these children were three servings/day of cereals and cereal products; one
serving/day of fruits; two servings/day of dark green leafy vegetables [cabbage (one
serving/day)]; two servings/day of meat, fish and eggs [chicken eggs (one
serving/day)]; one serving/day of legumes, nuts and seeds; and one serving/day of
dairy products., with a daily cost of RM 5.30. For undernourished urban poor
children aged four to five years, folate, vitamin C, and zinc were identified as partial
problem nutrients. The final FBRs for these children were three servings/day of
cereals and cereal products; one serving/day of fruits; two servings/day of dark green
leafy vegetables; two servings/day of meat, fish and eggs [chicken eggs (one
serving/day)]; one serving/day of legumes, nuts and seeds; and two servings/day of dairy products [full cream milk (one serving/day)], with a daily cost of RM 6.50. In
conclusion, LP is expected to translate dietary requirements into healthy and well-
balanced dietary recommendations using only local foods to prevent undernutrition
at minimal cost through strategic selection of food combinations.
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