Phase 2: 5 - 75 years old THE REPORT : 2nd NHANSS ( Phase 2 : 5 - 75 years old)
Ministry of Health MINISTRY OF HEALTH Brunei Darussalam BRUNEI DARUSSALAM THE REPORT The 2nd National Health and Nutritional Status Survey (NHANSS)
2014
1 Copyright © Ministry of Health, Brunei Darussalam October 2015
All rights reserved. No part of this publication may be reproduced in any form or by any means, electronic, mechanical, photocopy and/or otherwise without prior written permission of the publisher.
ISBN: 978-99917-50-11-8
Published By Ministry of Health, Brunei Darussalam 2015
2 6 Foreword from the Minister of Health, Brunei Darussalam 7 Preface from the Deputy Permanent Secretary 8 Acknowledgements 9 Project Team 10 List of Tables 11 List of Figures 14 Glossary 18 Abbreviations 19 Executive Summary 23 1.0 Background 24 2.0 Objectives 26 3.0 Method 26 3.1 Overview of Survey Method 26 3.2 Sampling Procedure and Selection 27 3.2.1 Selection of Sample of Segments from Frame 27 3.2.2 Selection of Housing Units in Selected Segments 28 3.2.3 Distribution of Segments Selected into 12 Replicates (or Survey Months) 28 3.2.4 Household Members Selection 28 3.2.5 Sub-Sampling Methodology for Phase 2 of 2nd NHANSS 29 3.2.6 Exclusion Criteria 29 3.3 Questionnaire Development 30 3.4 Database Development 30 3.5 Pilot Testing 30 3.6 Training 32 4.0 Promotion and Public Awareness 32 5.0 Data Collection 33 5.1 Blood Pressure 33 5.2 Anthropometry 33 5.3 Physical Activity 33 5.4 Dietary Assessment 33 5.4.1 24-Hour Dietary Recall 34 5.4.2 Food Frequency Questionnaire 35 6.0 Data Management 35 6.1 Data Entry and Cleaning for Database 1 35 6.2 Dietary Data Entry and Cleaning for Database 2 35 7.0 Data Analysis 3 37 8.0 Results 37 8.1 Demographic Characteristics 37 8.1.1 Survey Population by Gender and District 37 8.1.2 Survey Population by Age-Groups 38 8.1.3 Survey Population by Residential Status 38 8.1.4 Survey Population by Ethnicity and Religion 39 8.1.5 Survey Population by Marital Status 41 8.2 Socioeconomic Status (Respondents Aged 18-75 Years) 41 8.2.1 Housing Status 41 8.2.2 Electricity and Piped Water Supply 42 8.2.3 Employment Status 44 8.2.4 Education Level 46 8.2.5 Income Level 47 8.2.6 Food Security 47 8.3 Smoking Status 47 8.3.1 Percentage Smoking Habits Among Respondents (19-75 Years Old) 48 8.3.2 Period When Smoking Commenced and Ceased 49 8.4 Physical Activity 49 8.4.1 Physical Activity at Work 49 8.4.2 Travel to and from Places 49 8.4.3 Recreational Physical Activity 49 8.4.4 Resting and Televison Viewing 52 8.5 Health Status and Illness Amongst Respondents Aged 19 Years and Above 52 8.5.1 History of Hypertension 53 8.5.2 History of Diabetes 54 8.5.3 History of Dyslipidaemia 56 8.6 Anthrophometric Measurements 56 8.6.1 Stunting Among the 5-19 Years Old 57 8.6.2 BMI-for-age Amongst the 5-19 Years Old 58 8.6.3 Anthropometric Measurements Amongst ≥19 Years Old 58 8.6.3.1 Mean Weight 58 8.6.3.2 Mean Height 59 8.6.3.3 Mean Waist Circumference 2 60 8.6.3.4 Mean Body Mass Index (BMI-kg/m ) 60 8.6.3.5 Body Mass Index (BMI) Categories 60 8.6.3.5.1 Underweight 60 8.6.3.5.2 Overweight 60 8.6.3.5.3 Obesity 62 8.7 Body Image 64 8.8 Food and Nutrient Intake 64 8.8.1 24-hour Dietary Recall 64 8.8.1.1 Energy Intake 66 8.8.1.2 Carbohydrate Intake 67 8.8.1.3 Protein Intake 69 8.8.1.4 Fat Intake 72 8.8.1.5 Percentage Energy Contribution of Macronutrients to the Total Energy Intake 73 8.8.1.6 Fibre Intake 75 8.8.1.7 Vitamin A Intake 76 8.8.1.8 Calcium Intake 77 8.8.1.9 Iron Intake 78 8.8.1.10 Zinc Intake 79 8.8.2 Short Food Frequency Questionnaire 79 8.8.2.1 Fruit Intake 79 8.8.2.2 Vegetable Intake 80 8.8.2.3 Percentage of Respondents Eating 5 Servings of Fruit and/or Vegetables 81 8.8.2.4 Meals Not Prepared at Home 81 8.8.2.5 Breakfast 82 8.8.2.6 Types of Milk 83 8.8.2.7 Sugar-Sweetened Beverages/Soft Drinks 83 8.8.2.8 Instant Drinks 84 8.8.2.9 Types of Cooking Oil 84 8.8.2.10 Coconut Milk 85 8.8.2.11 Malay “Kuih” 85 8.8.2.12 Fast Food 86 8.8.2.13 “Nasi Katok” 86 8.8.2.14 Chicken Tail, Wing and Skin 87 8.8.2.15 Instant Noodles 87 8.8.2.16 Crisps (“Keropok”) 88 8.9 Use of Food Supplements 88 9.0 Blood Pressure and Biochemical Analyses for Age 20-75 Years Sub-groups 89 9.1 Blood Pressure 91 9.2 Diabetes 93 9.3 Lipids 94 9.4 Creatinine 96 9.5 Haemoglobin 98 10.0 Conclusion 100 11.0 References 102 12.0 Appendices 103 Appendix A 139 Appendix B 160 Appendix C 163 Appendix D 164 Appendix E Foreword from the Minister of Health Brunei Darussalam
Alhamdulillahi Rabbil ‘Alamin. Wassalatuwassalamu ‘Ala Ashrafilmursalin. Sayyidina Muhammadin Wa ‘ala alihi wasahbihi ajmain
Alhamdulillah, with the blessings of Allah Subhanahu Wata’ala, it is my great pleasure to share the findings of The 2nd National Health and Nutritional Status Survey (NHANSS) 2010-2011 (Phase 2) for Brunei Darussalam. This Report provides an important insight into the health behaviours, nutritional and health status for people aged 5 to 75 years old.
The survey provides us with an extremely valuable data resource on smoking behaviour, physical activity, body mass index, dietary intake and food consumption patterns. It has a special focus on the prevalence of non-communicable diseases (NCDs) including diabetes mellitus, hypertension and hyperlipidaemia which are associated risk factors for cardiovascular diseases, the leading cause of morbidity and mortality in Brunei Darussalam.
The report from this survey will provide an updated and comprehensive information on the health and nutritional status of Brunei Darussalam.
With each additional survey conducted, the ability to analyse trends will add considerably to the usefulness of this data source. The information gathered will aid the Ministry of Health and other stakeholders to assess the effectiveness and relevance of existing programs, strategies and interventions to control and reverse the trend in NCDs. This will prove to be vital in aiding better understanding of health issues and helping policy and decision makers to formulate and review policies to improve services.
I wish to congratulate the survey team in successfully carrying out the The 2nd National Health and Nutritional Status Survey (NHANSS) 2010-2011 (Phase 2) for Brunei Darussalam and writing this comprehensive report.
My appreciation goes to the Department of Economic Planning and Development of the Prime Minister’s Office for their support including funding to conduct the survey. I would like to acknowledge the expert guidance and valuable contributions received from Consultants at The Boden Institute of Obesity Nutrition, Exercise & Eating Disorders, University of Sydney, Australia throughout the survey and for their assistance in analysing the data.
Finally, I would also like to thank the people who have spared their valuable time and contribution in participating in this survey which provides a better understanding of the status of our nation’s health.
Pehin Orang Kaya Johan Pahlawan Dato Seri Setia Awang Haji Adanan Bin Begawan Pehin Siraja Khatib Dato Seri Setia Haji Awang Mohd Yusof Minister of Health Brunei Darussalam 6 Preface from the Deputy Permanent Secretary
Alhamdulillahi Rabbil ‘Alamin. Wassalatuwassalamu ‘Ala Ashrafilmursalin. Sayyidina Muhammadin Wa ‘ala alihi wasahbihi ajmain
For more than three decades Noncommunicable Diseases (NCDs) has marked its presence as the top cause of deaths in Brunei Darussalam. Current trends indicate NCDs will continue to dominate our health landscape with significant potential impacting amongst others on socio-economic development, increasing burden on health care services, escalation of health care cost and challenges to our quality of life. Therefore it is imperative that that the ongoing NCDs trends is monitored closely and objectively over set time intervals to maintain checks on key related indicators pertinent in the control and prevention of the diseases covering the spectrum from risk factors to intervention programmes and outcomes.
The publication of this Report following the completion of the Second National Health and Nutrition Status Survey – Phase 2 is much awaited, as specifically it covered a nationally representative sample of people aged 5 to 75 years capturing information on dietary habits, nutritional status and associated risk factors for NCDs. This Report is thus of high value in the surveillance of NCDs in the country particularly in identifying areas for priority action, in evaluating policy and programme interventions and tracking progress for non-communicable diseases (NCDs), as set out in the Brunei Darussalam National Multisectoral Action Plan for the Prevention and Control of NCDs 2013-2018.
Additionally, the information collected from this survey will also contribute significantly to the existing body of population data gathered from other surveys to date, hence enabling cross comparisons over time and for different target groups. Furthermore, beyond this Report, the rich field of data gathered will also offer invaluable opportunities for in- depth research and analysis allowing us to delve further, sharpen our understanding of the dynamics of NCDs in Brunei Darussalam and refine our management approaches.
In concluding, my sincerest appreciation and congratulation to the team and all involved for successfully completing the through task from planning to roll-out of the survey followed by the meticulous handling of raw data to analysis and finally the publication of this much welcomed Report. My gratitude and heartfelt thank you too goes to all respondents in the Survey for without your willingness and openness the Survey would not have been successful.
Dr Hjh Rahmah Bte Hj Md Said Deputy Permanent Secretary (Professional & Technical) As Chair of National NCD Prevention and Control Strategic Planning Committee Ministry of Health Brunei Darussalam 7 Acknowledgements
Alhamdulillahi Rabbil ‘Alamin. Wassalatuwassalamu ‘Ala Ashrafilmursalin. Sayyidina Muhammadin Wa ‘ala alihi wasahbihi ajmain
Alhamdulillah, this Phase 2 of the Second National Health and Nutritional Status Survey (2nd NHANSS), Brunei Darussalam, 2010-2011 was carried out by the Ministry of Health in collaboration with the Department of Economic Planning and Development of the Prime Minister’s Office under the 9th National Development Plan and the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders (BIONE) at the University of Sydney, Australia.
The dedication and perseverance of project staff from the Community Nutrition Division and Community Nursing Division, Department of Health Services; Medical and Health Statistics Unit of Department of Policy and Planning, consultants from the Endocrine Unit of the Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital under the Department of Medical Services, the research assistants and the secretariat have made this survey a successful endeavour. The continuous support from Permanent Secretary and Deputy Permanent Secretaries, Ministry of Health throughout the survey period was also highly valued.
The survey, conducted as a national project would also not have materialised without the contributions from the following sectors of the Ministry of Health: Directorate and Administration of Department of Health Services; Directorate of Department of Environmental Health Services, Disease Control Division; Division of Estate Management and Development; Department of Health Care and Technology; Department of Administration and Finance; Department of Policy and Planning, Public Relation Division; the Health Promotion Centre; Diabetes Nurse Educators from Diabetes Centre, RIPAS Hospital; members of staff of Health Centres and District Health Offices throughout the country and the Dietetic Unit, Department of Medical Services.
The current collaboration between BIONE and Ministry of Health, Brunei Darussalam on NHANSS 2010- 2011 was headed by Professor Ian Caterson, Professor Adrian Bauman, Associate Professor Tim Gill, Dr Anna Rangan, Dr Sinead Boylan and Dr Jimmy Louie Chun Yu. Associate Professor Tim Gill headed the team on technical aspects of the survey, diligently guiding us through the analysis and reporting of this survey. We would also like to extend our appreciation to Professor Stephen Colagiuri and his team on the technical input for the Diabetes Prevalence Sub-Study and Biochemistry Analysis.
To our family, friends and colleagues, we appreciate your tolerance and understanding throughout the challenging times. Our heartfelt thanks goes to our respondents of the survey, as this would not be achievable without their participation. 8
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9 List of Tables Tables Title Page
Table 1 Distribution of Samples by Districts 29
Table 2 Arm Circumference and Cuff Size 33
Table 3 Respondents by Gender and Districts 37
Table 4 Proportions of Respondents in Each Category 37
Table 5 Age When Smoking Commenced and Ceased (≥19 years) 48
Table 6 Percentage Respondents Not Meeting Brunei Recommendations on Moderate Physical Activity for Health (<150 minutes/week) 49
Table 7 Physical Activity and Sedentary Behaviour Amongst Respondents (19 Years and Above) 50
Table 8 History of Hypertension 52
Table 9 Status on Blood Glucose Testing and Diabetes 53
Table 10 Status of Blood Cholesterol Testing and Dyslipidaemia 54
Table 11 Anthropometric Measurements Amongst 5-19 Years Old 58
Table 12 Anthropometric Measurements Amongst ≥19 Years Old 59
Table 13 Proportion of Respondents ≥19 Years Old Across BMI Categories 61
Table 14 Self-Rated Weight Status Amongst Respondents 62
Table 15 Energy Intake 64
Table 16 Carbohydrate Intake 66
Table 17 Protein Intake 67
Table 18 Fat Intake 69
Table 19 Fibre Intake 73
Table 20 Vitamin A Intake 75
Table 21 Calcium Intake 76
Table 22 Iron Intake 77
Table 23 Zinc Intake 78
Table 24 Types of Food Supplements Used By Respondents 88
Table 25 Characteristics of Respondents Aged ≥20 Years of Age 88
Table 26 Proportion of Respondents Aged ≥20 Years by Gender and Ethnicity 89
10 List of Figures Figures Title Page
Figure 1 Flowchart of Data Collection Process 32
Figure 2 Residential Status 38
Figure 3 Ethnicity 38
Figure 4 Religion 39
Figure 5 Marital Status 39
Figure 6 Housing Status 18-75 Years Old 41
Figure 7 Percentage Respondents 18-75 Years Old by Employment Status 42
Figure 8 Percentage Respondents <18 Years Old by Parental Employment Status 43
Figure 9 Percentage Respondents 18-75 Years Old by Education Level 44
Figure 10 Percentage Respondents <18 Years Old by Parental Education 45
Figure 11 Percentage Respondents 18-75 Years Old by Monthly Income 46
Figure 12 Percentage Respondents <18 Years Old Total Parental Monthly Income 46
Figure 13 Percentage Respondents Age 18-75 Years Old on Food Security 47
Figure 14 Percentage Smoking Habits Amongst Respondents 19-75 Years old 47
Figure 15 Percentage of Moderate Stunting Amongst 5-19 Years Old 56
Figure 16 Percentage of Severe Stunting Amongst 5-19 Years Old 57
Figure 17 Percentage Contribution of Energy Intake from Food Sources 65
Figure 18 Percentage Contribution of Carbohydrate Intake from Food Sources 67
Figure 19 Percentage Contribution of Protein Intake from Food Sources 68
Figure 20 Mean Percentage of Energy from Fat Intake 69
Figure 21 Percentage Consuming >30% Energy from Fat Intake 70
Figure 22 Mean Percentage of Energy from Saturated Fat Intake 70
Figure 23 Percentage Consuming >10% Energy from Saturated Fat Intake 71
11 List of Figures Figures Title Page
Figure 24 Proportion of Total Fat Intake Obtained from Food Sources 71
Figure 25 Proportion of Total Saturated Fat Intake Obtained from Food Sources 72
Figure 26 Percentage Energy Contribution of Macronutrients to Total Energy Intake Amongst 18 Years and Below 72
Figure 27 Percentage Energy Contribution of Macronutrients to Total Energy Intake Amongst Adults 73
Figure 28 Percentage Contribution of Fibre Intake from Food Sources 74
Figure 29 Percentage Contribution of Vitamin A Intake from Food Sources 75
Figure 30 Percentage Contribution of Calcium Intake from Food Sources 76
Figure 31 Percentage Contribution of Iron Intake from Food Sources 77
Figure 32 Percentage Contribution of Zinc Intake from Food Sources 78
Figure 33 Fruit Intake 79
Figure 34 Vegetable Intake 80
Figure 35 Percentage of Respondents Eating 5 Servings of Fruit and/ or Vegetables Daily 80
Figure 36 Percentage of Respondents Having Meals Not Prepared at Home 81
Figure 37 Percentage of Respondents Having Breakfast Daily 81
Figure 38 Percentage Milk Consumption Amongst Respondents by Age-Groups 82
Figure 39 Percentage Daily Consumption of Sugar-Sweetened Beverages 83
Figure 40 Percentage Daily Consumption of Instant Drinks 83
Figure 41 Percentage of Cooking Oil Most Used by Respondents 84
Figure 42 Percentage of Weekly Usage/Consumption of Coconut Milk 84
Figure 43 Percentage of Respondents Consuming Malay ‘Kuih’ 85
Figure 44 Percentage of Respondents Consuming Fast Food 85
Figure 45 Percentage of Respondents Consuming ‘Nasi Katok’ 86 12 List of Figures Figures Title Page
Figure 46 Percentage of Respondents Eating Chicken Tails, Wings or Skin 86
Figure 47 Percentage of Respondents Consuming Instant Noodles 87
Figure 48 Percentage of Respondents Eating Crisps (‘Keropok’) 87
Figure 49 Percentage of Respondents for Hypertension by Age Groups 89
Figure 50 Percentage of Respondents for Hypertension According to Gender 90
Figure 51 Percentage of Respondents with Hypertension According to Ethnicity 90
Figure 52 Percentage of Respondents According to Glucose Tolerance Status by Age Groups 91
Figure 53 Percentage of Respondents with Diabetes by Age Groups 91
Figure 54 Percentage of Respondents According to Glucose Tolerance Status by Gender 92
Figure 55 Percentage of Respondents According to Glucose Tolerance Status Amongst The Ethnic Groups 92
Figure 56 Percentage of Respondents within Age Group for Abnormal Lipid Levels 93
Figure 57 Percentage of Respondents for Abnormal Lipid Levels by Gender 93
Figure 58 Percentage of Respondents for Abnormal Lipid Levels by Ethnicity 94
Figure 59 Percentage of Respondents with Abnormal Creatinine Values by Age Groups 94
Figure 60 Percentage of Respondents with Abnormal Creatinine Values According to Gender 95
Figure 61 Percentage of Respondents with Abnormal Creatinine Values According to Ethnicity 95
Figure 62 Percentage of Respondents within Subgroup for Anaemic Status by Age Groups 96
Figure 63 Percentage of Respondents for Anaemia Status - Overall Figures 96
Figure 64 Percentage of Respondents for Anaemia According to Gender 97
Figure 65 Percentage of Respondents within Subgroup for Anaemia Status According to Ethnicity 97
13 Glossary Ready to eat, packaged white rice with a piece of fried chicken (normally ‘Nasi Katok’ battered) accompanied with spicy gravy
24-hour dietary A type of dietary assessment method that collects information on all foods recall and beverages consumed in a period of 24-hour
Anthropometric Measurement of height and weight, and waist circumference Measurement
Cholesterol is a waxy, fat like substance that are found in most body tissues including blood. It comes from 2 major sources, foods of animal Blood Cholesterol origin or synthesised by liver. Elevated cholesterol level is associated with an increased risk for heart and blood vessel disease
A simple index of weight-for-height that is commonly used to classify under- Body Mass Index weight, overweight and obesity in adults. BMI is calculated by dividing weight (BMI) in kilogram by height in metres squared (kg/m2)
Cerebrovascular disease refers to a group of conditions that affect the Cerebrovascular circulation of blood to the brain, causing limited or no blood flow to affected Disease areas of the brain
Cluster or ‘Mukim’ Subdivision of a district. Equivalent English word is sub-district
A milky liquid extracted from the grated flesh of a coconut, used in foods or as Coconut Milk a beverage. It is usually white in colour and has a rich taste of milk that can be attributed to the high oil content. Most of the fat is saturated fat
Crunchy wafer-thin slices or finger-like products made from potato, or banana or ingredients containing a mixture of wheat, corn or rice flour. Flavourings Crisps or ‘Keropok’ added may include prawns, fish, mussels, squid, onions, chillies, cheese, curry powder, salt, pepper and monosodium glutamate. They are usually eaten as a snack
A type of survey that collects data to make inferences about a population of Cross-sectional interest at one point in time. It is also described as snapshots of the populations survey about which they gather data
Subjects are asked about recent feeding practices, usually in the previous 24 Current practices hours. This is distinct from recalled practices that occurred sometime in the past: for example, weeks or months or years ago
A disorder of carbohydrate metabolism characterised by chronic elevated Diabetes blood glucose levels due to inadequate production of insulin and/ or reduced effectiveness of insulin action Food designed or made or prepared for ready and quick availability for Fast Food consumption 14 Fatty Acids come from animal and vegetable fats and oils. They are either Fatty Acids saturated or unsaturated. The three main types of fatty acids in the diet are: saturated, monounsaturated and polyunsaturated
Access to adequate, safe, affordable and acceptable food. In contrast, food Food Security insecurity occurs when the availability of nutritionally adequate and safe foods, or the availability to acquire such foods, is limited or uncertain
FoodWorks® A nutrition analysis software program that use the AUSNUT (Food Standards Australia New Zealand’s Nutrient Database) database and it is used for professional nutritional analysis of the 24-hour dietary recalls
The liquid extracted from fruit either as pure 100% juice or with water added, Fruit Juice with or without added sugar
Gestational Diabetes of first onset or detection during pregnancy Diabetes Mellitus Glycated A measurement of the average plasma glucose over the previous eight to Haemoglobin twelve weeks. It is expressed as a percentage (HbA1c)
Hari Raya Festive month on the tenth month of the lunar Islamic calendar which marks Aidilfitri the end of the fasting month of Ramadhan
Defined as information collected on a range of health indicators including Health Status overweight and obesity, self-reported history of hypertension, diabetes, dyslipidaemia and other medical conditions
Medical term for high blood pressure. A blood pressure level Hypertension of ≥140/90 mmHg is termed hypertension
Drinks designed for quick preparation and are readily soluble in hot Instant Drinks or cold water
Dried precooked (often in oil) noodle block sold with flavouring powder and / or Instant Noodles seasoning oil, usually in a separate packet
A hormone produced in the pancreas by the islets of Langerhans, which Insulin regulates the amount of glucose in the blood
A particle that transports cholesterol and triglycerides, two compounds Lipoprotein essential to cell structure and metabolism. Lipoproteins are comprised of proteins (apolipoproteins), phospholipids, triglycerides and cholesterol
Bite-sized snacks or dessert foods (cake, pudding, biscuits or pastries); are Malay ‘Kuih’ usually sweet but some are savoury. They are traditionally made of flour, sugar and oil or fats
Monounsaturated Monounsaturated fatty acids are found in nuts, vegetable oils Fatty Acid (MUFA) (such as canola and olive oil) and avocadoes
15 Also known as chronic diseases and not passed from one person to person. NCDs are of long duration and generally slow progression. The four main Non-communicable types of NCDs are cardiovascular disease (such as heart attacks and stroke), Disease (NCD) cancers, chronic respiratory disease (such as chronic obstructed pulmonary disease and asthma) and diabetes
Macronutrient- Nutrients that are needed in larger quantities (e.g. protein, carbohydrate and fat) Nutrient Micronutrient- Nutrients that are needed in smaller quantities (e.g. vitamins and minerals)
The general health status of the body as a result of the intake, absorption and Nutritional Status use of nutrition and the influence of disease-related factors
Abnormal or excessive fat accumulation that presents a risk to health with a Obesity body mass index (BMI) greater than or equal to 30
Abnormal or excessive fat accumulation that presents a risk to health with a Overweight body mass index (BMI) greater than or equal to 25
Any bodily movement produced by skeletal muscles that requires energy Physical Activity expenditure
Differ from saturated fatty acids in its chemical structure and has been Polyunsaturated shown to have cholesterol-lowering effect. Food sources include plant-based Fatty Acids (PUFA) food such as corn, soybean, sesame and sunflower oils. Other sources in- clude oily fish
The ninth month of the Muslim year, in which fasting is obligatory for all Muslim. Ramadhan Muslims all over the world abstain from eating, drinking, smoking as well as participating in anything that is ill-natured or excessive; from dawn to sunset
The RNIs are essential standards against which nutrients in food eaten can Recommended be assessed for its adequacy in any given population. The RNI provides dietary recommendation for energy, protein, carbohydrates (including dietary fibre), Nutrient Intake* vitamins (thiamin, riboflavin, niacin, folate, vitamin C, vitamin A, vitamin D and (RNI) vitamin E) and minerals (calcium, iron, iodine, zinc and selenium) *For this survey, the RNI used is based on Malaysian RNI Regular Food or drink consumed on a daily basis at least 1-2 servings per day consumption
Retinol Equivalent The recommendation for vitamin A intake is expressed as micrograms of retinol equivalents. One microgram (1 μg) of retinol equivalent equals 1 μg of (RE) retinol, or 6 μg of ß-carotene
Saturated fatty acids is a type of fat in food which mainly come animal-based Saturated Fatty foods such as high-fat cut of meat, butter, whole milk, whole milk products and cheese, and from coconut, palm and palm kernel oils. Most saturated Acid fatty acids are solid at room temperature. Saturated fatty acids are the most cholesterol-raising components of our diet 16 These are usually ready to eat crispy dry food made of flour, salt, monosodium Salty Snacks glutamate, preservatives, colouring and are usually fried and may contain aritificial flavourings
One medium piece of fruit; two pieces of small fruit ; one-third cup cut fruit or Serving of Fruit one tablespoon dried fruit
Serving ½ cup cooked leafy and fruit vegetable or a cup of raw vegetable, salad vegetable, fresh, dried, frozen or canned vegetable (does not include vegetable of Vegetable juices)
Sweetened Drinks with added sugar Beverages
Moderate underweight in children is defined as two standard deviations below the median weight for age of the reference population. Severe underweight in Underweight children is defined as three standard deviations below the median weight for age of the reference population. In adults, a body mass index of below 18.5 is categorised as underweight
17 bbreviations
ND A 2 NHANSS The Second National Health and Nutritional Status Survey AUSNUT Food Standards Australia New Zealand’s Nutrient Database BIONE Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders BMI Body Mass Index CDC Centre for Disease Control and Prevention CND Community Nutrition Division FFQ Food Frequency Questionnaire GPAQ Global Physical Activity Questionnaire OGTT Oral Glucose Tolerance Test HbA1c Glycated Haemoglobin HDL High-density Lipoprotein Cholesterol HES Household Expenditure Survey HND Higher National Diploma HUs Housing Units IMR Infant Mortality Rate kcal Kilocalorie LDL Low-density Lipoprotein Cholesterol MOH Ministry of Health MUFA Monounsaturated Fatty Acid NCD Noncommunicable Disease PhD Doctor of Philosophy PPS Probability Proportional to Size PUFA Polyunsaturated Fatty Acids RE Retinol Equivalent RNI Recommended Nutrient Intake SD Standard Deviation SPSS Statistical Package for Social Sciences U5MR Under-Five Mortality Rate WHO World Health Organization WHO STEPS World Health Organization (WHO) STEPwise Approach to Surveillance
18 Executive Summary This report presents the results from Phase 2 of the 2nd National Health and Nutritional Status Survey, Brunei Darussalam, carried out by the Ministry of Health in collaboration with Department of Economic Planning and Development, Prime Minister’s Office and Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders (BIONE), University of Sydney, Australia.
Data collection was carried out on the population aged 5 to 75 years old throughout the four districts from June 2010 till March 2011.
The health and nutritional indicators were obtained by interview using pre-tested and validated questionnaire looking into the following components : • Demographics • Socio-Economic Status • Smoking Status • Physical Activity • History of Increased Blood Pressure • History of Diabetes Mellitus and Dyslipidaemia • History of Health Status • Body Image • Dietary Assessment through questions on Food Supplements • Food Frequency Questionnaire • 24-Hour Diet Recalls • Blood Pressure measurement • Anthropometric measurements • Biochemical analysis
From the calculated target of 4000 participants, 2184 responded to the survey (54.6% response rate) with 67.7% from Brunei Muara, 17% from Belait, 12% Tutong and 3.3% Temburong districts. The respondents comprised of 53% females, 92.8% Brunei Darussalam Citizens and 88% of the Muslim faith. The majority of the respondents (87.2%) were of the Malay group.
Socio-Economic Status • In this survey, 42.3% of the respondents lived in their parents’ houses and 35.6% lived in their own houses • Amongst the 18 to 75 years old, 38.3% were government employees, 21.1% worked with the private sector while 15.7% were unemployed • It was observed that 55.3% reached secondary level education and 10.4% achieved tertiary / higher level education as the highest level of education • In relation to individual food security, 92.6% of respondents aged 18 to 75 years old did not report encountering food shortage and experienced financial difficulty to purchase food in the past twelve months
19 Smoking Prevalence • Amongst the 19-75 age group, 35.5% of males were current smokers compared to 4% in the female population • The median age at which smoking started was 18 years for both genders • The median number of cigarette sticks smoked per day was ten for males and four for females
Physical Activity • Only 64.5% of the respondents met the recommended National Physical Activity Guidelines of more than 150 minutes per week of physical activity of moderate intensity for health • The median time spent on total physical activity for all respondents was 45 minutes per day • Time spent on sport-related physical activity was at a mean of 45.9 minutes per day • The respondents spent a mean of 258.3 minutes per day resting or being inactive and a mean of 110.4 minutes per day watching television. The total sedentary time spent on resting or being inactive and watching television was a mean of 368.4 minutes per day
Hypertension • Within the last 12 months, 64.0% respondents reported to have had their blood pressure measured and 19.0% self-reported to be hypertensive • Amongst the 20-75 years old age group, 33.8% were found to be hypertensive
Diabetes Mellitus • 17.2% respondents self-reported to have diabetes of which 14.8% were on insulin injections and 78.3% were on oral hypoglycaemic medication(s) • 5.0% of the female respondents recalled having diabetes during pregnancy • Amongst the 20-75 years old age group, the prevalence of diabetes was 12.4%
Dyslipidaemia • 37.1% of the respondents self-reported to have dyslipidaemia of which 76.7% were on medication(s) • Amongst the 20-75 years old age group, the prevalence of dyslipidaemia was 73.8%
Creatinine • Abnormal creatinine levels were seen in 2.4% of the 20-75 years old age group
Anaemia • 85.7% were non-anaemic in the 20-75 years old age group • Amongst those with anaemia, the female had a higher incidence at 22.5% compared with 4.6% seen in male respondents
20 Anthropometrics • In the 5-19 years age group, 15.6% were moderately stunted and 2.3% were severely stunted • Amongst the 5-19 years age group, using BMI-for-age, 33.5% were overweight and 18.2% were obese • 41.6% were overweight and 23.6% were obese in the 10-14 years age group • Amongst adults 19 years old and above, 5.1% were underweight, 33.4% were overweight and 27.1% were obese. Overall, 60.5% of this age group had BMI of more than 25kg/m2
Dietary Intake – 24-hour Dietary Recall • The median daily energy intake ranged from 1381 to 1714 kcal in males and 957.5 to 1400 kcal in females. Across all the age groups for both genders, the energy intake was lower than the RNI • In all age-groups, 50-55% of energy intake was derived from carbohydrates • The median daily protein intake was 67.3 grams in males and 53.6 grams in females. Overall, 70.7% of males and 54% of females met the RNI for protein intake • 53.3% of males and 54.6% of females derived more than 30% of their total energy from fat • Although saturated fat contribution towards energy ranged only from 9.5-10.8% in males and 10.4-11.4% in female, 55.4% males and 58.5% females consumed higher than the recommended 10% energy from saturated fat • The daily dietary fibre intake was low in both genders with 33.5% males and 21.3% females meeting 70% of the RNI • The average daily Vitamin A intake was low at 362.8 RE/μg per day for males and 321.8 RE/μg for females. A total of 38.2% males and 38.3% females achieved 70% of the RNI • Median daily calcium intake was 391.1 mg in males and 337.9 mg in females. Only 22.9% of males and 15.8% of females met 70% of the RNI • The median daily iron consumption was 8.2 mg in males and 7.0 mg in females. Only 18.3% of females met 70% of the iron RNI as compared to 78.2% of males • The daily zinc intake was better compared to the other micronutrients with a median daily intake of 6.5 mg in males and 5.1 g in females, with majority meeting 70% of the RNI
Dietary Intake – Food Frequency • Low fruits and vegetables intake was reported amongst the respondents with only 8.2% who consumed the daily national recommendation of servings of fruits and/or vegetables • Breakfast was not consumed daily by the respondents with the lowest percentage at 41.3% in males and 43% in females amongst the 15-18 years age group • The most commonly consumed milk was sweetened condensed milk at 33.1% overall • Palm-based oil was the most commonly used cooking oil in the household, with 77.1% of respondents reported using it most often for meal preparation. Only 17.3% used polyunsaturated oil for their cooking purposes and 3.1% used monounsaturated cooking oil
21 Survey team member delivering MOH formal letter to selected household
A prospective participant was informed verbally of the survey and their random selection
22 1
Background
Brunei Darussalam has achieved most of the health related targets set in the Millennium Development Goals (MDGs). These include significant reductions in the under-five mortality rate (U5MR) and infant mortality rate (IMR) where IMR has declined from 42.3 per 1000 live births in 1966 to 8.3 per 1000 live births in 2011. The immunisation rate in this country is also high at 91% while 99.7% of births were attended by skilled health personnel 1.
However the country is facing a rise in non-communicable diseases (NCDs) such as cancer, heart disease, diabetes mellitus and cerebrovascular disease, which accounts for half of the total number of deaths. Previous reports have also shown similar trends with cancer or heart disease being the leading cause of mortality in the country 1. This is largely driven by a change in dietary and lifestyle patterns which has led to a rise in obesity, a known risk factor for NCD. This was reflected in the 1st National Nutritional Status Survey (NNSS) done in 1997 which showed that 32% of the population was overweight and 12% being obese amongst adults 20 years old and above 2. The 1st NNSS also showed that 31.1% of the males were in the ‘current smokers’ group where the highest rate was recorded among the younger males aged 20 to 29 years old (44%) 2.
The Phase 2 of the Second National Health and Nutritional Status Survey (2nd NHANSS) is a continuum of the Phase 1 NHANSS 3. It was conducted to provide an updated and comprehensive information on the health and nutritional status of the country. The information gathered will aid the Ministry of Health and other stakeholders to assess the effectiveness and relevance of existing programs, strategies and interventions to halt the rise in NCD. It will also provide a snapshot on the adequacy of the current dietary intake of older children, adolescents, adults and elderly in the country.
23 2
Objectives
The survey was conducted to assess the health and nutritional status and the dietary habits of the population aged 5-75 years old. The main objectives of this survey were:
1. To assess and update anthropometric data of the population and to examine their relationship to social, dietary and health data.
2. To provide a more recent quantitative information on dietary habits, nutrient intakes and food consumption patterns.
3. To examine the characteristics of “at risk individuals” in terms of their nutrient intake adequacy and in relation to the recommended intake.
4. To provide baseline and/or update national data on other health status indicators such as smoking, physical activity, NCD and biochemical measurements.
5. To assess the changes in trends in health, nutritional and dietary intake status since 1997 and, to compare it with the regional and international community.
6. To provide vital information to internal users such as physicians, dietitians, nutritionists and health promoters and, to external users such as the food producers and regulators.
7. To evaluate and revise past and current programs, in particular those in line with NCD prevention and control.
24 Registration of participants
Participants being interviewed by research assistants
Trained research assistant collecting blood samples from a participant
25 3 Method
This 2nd NHANSS Phase 2 is expected to provide information on nutrition-related of indicators of children and adults in Brunei Darussalam.
3.1 Overview of Survey Method Phase 2 of the 2nd NHANSS was implemented from June 2010. Data collection was temporarily halted in August 2010 during the fasting month of Ramadhan and the “Hari Raya Aidilfitri” festivities as this will not be reflective of the usual daily dietary patterns. The process of data collection was resumed in October 2010 until March 2011. This survey was carried out in parallel with the Brunei Darussalam Household Expenditure Survey (HES) 2010/2011 implemented by the Department of Economic Planning and Development, Prime Minister’s Office. The 2010/2011 National HES also provided the sampling frame for the 2nd NHANSS.
The survey was a cross-sectional survey aimed at the population aged from 5-75 years old with an initial target of 4000 participants from all the districts in Brunei Darussalam.
District Health Offices, Health Centres, District Hospitals and the Community Nutrition Centre were used as survey sites. Face-to-face interviews with parents and/or caregivers (for children) and participants themselves were conducted by trained dietitians/nutritionists and research assistants using a questionnaire booklet (Appendix A). The anthropometric indices measured were the weight, height, and waist circumference. Blood pressure was also measured for all respondents using standard methodology (Appendix B) while biochemical measurements were only collected on those aged 20 years and above. The survey procedures and questionnaire were pilot tested prior to training and finalised accordingly for standardised data collection.
The questionnaire booklet was divided into sixteen sections consisting of both open- and close-ended questions. Questions provided information on demographic and socio-economic status, smoking status, physical activity, self-reporting of medical conditions (hypertension, diabetes and dyslipidaemia), health status in the last 12 months, body image, and food supplements. Anthropometric measurements and biochemistry analysis were also conducted. A food frequency questionnaire as well as a 24-hour diet recall method were used to collect information on food and beverages consumption. A second day recall was collected on at least 10% of the sample population to obtain variation in dietary intake within and between respondents.
The completed questionnaires were thoroughly inspected by principal investigators and head of data entry after the interviews.
3.2 Sampling Procedure and Selection A sample of healthy children and adults aged from 5-75 years old who are citizens or permanent residents of Brunei Darussalam residing in the country were selected for this phase of the survey. It was initially anticipated that at least 4000 children and adults aged 5-75 years old were needed.
The respondents were sub-sampled from the Brunei Darussalam Health Expenditure Survey (HES) 2010/2011. Selection of Housing Units in the Brunei Darussalam HES 2010/2011 was done in three different steps. This involved selection of segments from the segments listings mainframe of Brunei Darussalam, the selection of housing units within the selected segments and distribution of segments to 12 survey months. 26 The segments listings mainframe of Brunei Darussalam is specifically stratified to accommodate three of the four objectives of Household Expenditure Survey below: 1. To collect up-to-date and comprehensive information on the expenditure and income of the population. 2. To revise the lists and weightings of goods and services of the Consumer Price Index (CPI). 3. To collect information relating to calculations of Rate of Basic Requirements Needs. 4. To provide additional information for National Accounts Statistics and Social Statistics.
3.2.1 Selection of Sample of Segments from Frame Circular Systematic Sampling was used in the selection of a sample of segments from the frame.
Let the total number of segments in the hth stratum in the frame be Ah and ah the number of segments to be selected.
1) Compute the sampling interval Ih1 as follows:
Iℎ1 = Aℎ1 or 1
aℎ1 fℎ1
This is computed to the nearest whole number with decimal 0.5 rounded down.
2) Select a random number from 1 to Ah. This becomes R. 3) Compute the sequence of sampling numbers
R, R + Iℎ1, R + 2 Iℎ1, etc until exactly ah segments have been selected. Depending on the value of R, the selection may need to be continued from the end of the list to the beginning of the list until the required number of segments has been selected.
This procedure is used to select the number of required segments separately according to the Urban and Rural Stratum.
3.2.2 Selection of Housing Units in Selected Segments Linear Systematic Sampling with a decimal interval is used in the selection of Housing Units (HUs) numbered from 1 to Bhi from the selected segment. Compute the sampling interval Ih2 to 3 decimal places as follows:
1 Iℎ2 = fℎ2
fℎ Where fℎ2 = fℎ1
ah Σ bi ah And = and = fℎ Ah fℎ1 Ah Σ Bi
ah Σ bi is the total number of HUs to be in the sample and
Ah Σ Bi is the number of HUs in the stratum estimated for 2010. Select a four-figure random number from
1000 to 1000 x Ih2. This becomes R. 27 Compute the sequence of sampling numbers
R, R + Iℎ2, R + 2 Iℎ2, etc
Each whole number part of the sampling number selects the serially numbered HUs in the segment. This
procedure is continued until the end of the list of HUs in the ith segment.
3.2.3 Distribution of Segments Selected into 12 Replicates (or Survey Months) This next step is to distribute randomly the ‘a’ segments selected for the country into 12 replicates or sub-samples using the linear systematic selection. The ‘a’ segments, with those in the urban stratum followed by those in the rural stratum, are serially numbered in the order they were selected and the
sampling interval is Ir = 12. A random number is selected from 1 to 12 and this becomes R. Compute the sequence of sampling numbers:
R, R + Ir, R + 2Ir, etc
This procedure is continued until the end of the list and the first replicate is selected. Another random number different from that selected for the first replicate is used to select the second replicate. This procedure is continued until 12 replicates are selected.
3.2.4 Household Members Selection The Brunei Darussalam HES 2010/2011 by The Department of Economic Planning and Development, Prime Minister’s Office provided the Ministry of Healthnd 2 NHANSS team the list of people staying in each of the selected housing unit during the survey months. Each list consisted of: 1. Address and household particulars 2. Name of head of household 3. Total number of people household and gender 4. Contact telephone number 5. Household member names 6. Smart card or identity card number and colour of each household member 7. Date of birth of each household member 8. Gender of each household member
3.2.5 Sub-Sampling Methodology for Phase 2 of 2nd NHANSS The sample size for Phase 2 of 2nd NHANSS was taken as 1% of total population in 2008 (398,000) 4 which was rounded up to 4000 samples. Another 30% or 1200 respondents were added to the sample size to accommodate for non-responders, making it a total of 5200 respondents. A total of 1300 respondents were deducted from the total sample size (5200 respondents), as these numbers represent the sample size for first phase of 2nd NHANSS (0-5 years old). The remaining number of samples was further rounded up to 4000 samples. The samples were then distributed according to the population size of each district using the formula shown below:
District Sample size: Number of Population in District X Total Sample Total Number Brunei Population
28 At the start of nutritional survey, Brunei Darussalam HES 2010/2011 by The Department of Economic Planning and Development, Prime Minister’s Office had already been initiated earlier on. From this survey, thirty clusters (“Mukims”) were first sub-sampled using Probability Proportional to Size (PPS) sampling method to carry out the Phase 2 of 2nd NHANSS. The thirty “Mukims” (Table 1) were distributed into: sixteen (16) in Brunei Muara; four (4) in Belait; six (6) in Tutong and four (4) in Temburong.
Table 1 - Distribution of Samples by Districts Districts Population Samples Clusters / “Mukims” Brunei Muara 276600 2778 16 Belait 66000 663 4 Tutong 46600 458 6 Temburong 10100 101 4 Total 398300 4000 30
The household`s age groups were divided into two groups namely: Group A (below 20 years of age) and Group B (above 20 years of age). From each household, one child (Group A) and one adult (Group B) of opposite gender were selected. If no subject is available for selection in the Group A category, only one adult would be selected. Thus from each household two potential respondents were randomly chosen, one in the 5-19 years old group and the other in the 20-75 years old age-group. Fasting blood samples were collected from the 20-75 years old for biochemical measurements.
Formal letters from the Ministry of Health including survey pamphlets were delivered to the selected household by the survey team members. Prospective participants were informed again verbally of the survey and their random selection. Appointments were scheduled or rescheduled accordingly for participants to attend at their respective Survey Centres. Telephone calls were made to help remind the participants of their appointments three days prior to data collection. Participants and the parents/ caregivers of young participants were given flexibilities to choose their survey appointment dates.
3.2.6 Exclusion Criteria The exclusion criteria for the survey were as follows: 1. Subjects who are sick, hospitalised, convalescent, physically disabled or mentally challenged. If this was to occur, he or she will be replaced with the next person in the household close to his/her age of the same gender. 2. The selected female subject was pregnant. She will then be replaced with her sister nearest to her age living in the same household.
3.3 Questionnaire Development Discussions on the questionnaire design and contents were initiated in December 2009. The questionnaire development was guided by Boden Institute of Obesity, Nutrition and Exercise and Eating Disorders (BIONE) of The University of Sydney, Australia. The questionnaire was developed using standard components from the 1st National Nutritional Status Survey in 1997, the WHO STEPS Manual 5, the Brunei Darussalam HES 2010/2011 6 and health and nutrition survey questionnaires from the region and international community. Amendments were made in line with current policy requirements.
Further discussion was carried out during the team’s working visit to BIONE in March 2010. The sample size, demography, physical activity, anthropometric measurements, nutrient analysis, recipes and database development were also ascertained during this visit. Following a series of thorough pilot testing, the questionnaire booklet was further refined and divided into sixteen sections. 29 Section A enquired on demography while section B addressed on the socio-economic status covering housing status, electricity and water supply, employment, education and income. Section C recorded current and past smoking habits. Meanwhile section D enquired on physical activity based on the WHO`s Global Physical Activity Questionnaire (GPAQ) 7. The sections E, F, G and H assessed for history of hypertension, diabetes and dyslipidaemia respectively. Participants were asked to bring their medical treatment cards if any, and a photocopy of the prescription was attached to the questionnaire. Participants’ perception of their body image was enquired in section J while food supplements consumption was recorded in Section K. Anthropometric measurements for height, weight and waist cicumference were recorded in Section L. The blood pressure was measured twice as indicated in Section M. Food intake assessment was carried out through a semi-quantitative Food Frequency questionnaire (FFQ) and 24-hour diet recall in Section N and Section O respectively. Section P was carried out only on respondents aged 20 years old and above. Biochemical test results consisting of fasting blood glucose, full blood count, fasting lipid profile, serum creatinine, HbA1c and oral glucose tolerance test (for non-diabetics only).
3.4 Database Development The database development was managed by the Disease Control Division with the support from the Community Nutrition Division, the Statistics Unit of Research and Development Division and the Department of Policy and Planning. The master file database was created using SPSS version 15 for Windows 8, containing information on demography, socio economic status, household smoking status, physical activity, health status, body image, food supplements, food frequencies as well as anthropometric measures and blood analysis.
FoodWorks® Professional Version 2009 9 was utilized for nutritional analysis of 24-hour dietary recalls. Food and nutrient intakes were imported from FoodWorks® into a Microsoft Access database so that data could be prepared for nutrient analyses. This data was then exported to SPSS IBM Statistics 21.0. Results of nutrient intake were then merged with the master file database containing questionnaire data for further analysis.
3.5 Pilot Testing Every step of the data collection procedures were pilot tested in three different locations including a school, university and a governmental office involving participants of various ages. This was to allow the interviewers: • to detect any misinterpretation of questions • to estimate the length of time to complete questionnaire for each participant • to provide practical training for the interviewers • to test the validity of the intervention materials • to strengthen the questionnaire for better performance and • to finalise the survey questions and format
3.6 Training All members of the survey team comprising of dietitians, nutritionists, interviewers, research assistants, community health nurses and data-entry personnels attended a one-week training workshop for phase 2 from the 5th of May 2010. In addition to addressing all aspects of the survey, the workshop also covered communication skills, familiarisation of questionnaire content, interviewing techniques, anthropometric assessments and blood pressure measurements. To minimise interview bias, the interviewers received training to ensure consistent techniques. However, this does not completely eliminate recall bias by respondents as under and over reporting are commonly observed in any self reporting survey. This is frequently encountered with dietary recall or food consumption history. 30 Participant being interviewed by a community health nurse
Child participant’s blood pressure measurement being taken by a research assistant
Research assistants interviewing participants
Nursing staff checking blood sample forms
31 Promotion 4 and Public Awareness The public was alerted regularly about the survey prior to and throughout data collection through media channels via radio and television, television interviews and pamphlets, newspapers and, posters. 5 Data Collection Each team member was identified by a code number prior and throughout data collection. The fieldwork was conducted from 10th June 2010 until 30th March 2011 on every Monday to Thursday and Saturday with a break during the fasting month of Ramadhan and Hari Raya Aidilfitri. The flow of data collection process is shown in Figure 1. Consent was obtained from respondents aged 20 years old and above for blood samples to be taken for analysis of hemoglobin level, serum creatinine, fasting blood glucose, fasting lipids (HDL-C, LDL-C, total cholesterol and triglycerides) and glycated haemoglobin (HbA1c).
>20 years old GTT Registration Biochemistry (for non-diabetics) Section P
<20 years old
Completed Anthropometry questionnaires & Blood Pressure checked and verified
Interview Diet Interview Section A – M Section N – O
Figure 1: Flowchart of Data Collection Process
Trained research assistants conducted the interview for Section A to M while trained dietitians/ nutritionists were tasked for Section N to O. Dietitians/nutritionists were also involved in the interview for Section A to M, if needed.
Each participant, upon completion of the questionnaire, received souvenirs as tokens of appreciation. Participants without transportation had transportation arranged to and fro from their home to the survey centre. 32 Following the interviews, completed questionnaires were checked and verified by principal investigators and any errors were immediately clarified and corrected on the field. The head of data entry further verified the questionnaire before and after each data entry at the data entry center.
5.1 Blood Pressure Participants were advised to sit in the waiting area for at least five minutes prior to each blood pressure measurements with the Blood Pressure Monitor Omron T9P. The cuff sizes were adjusted where necessary for each participant depending on their arm circumference (Table 2). Two readings of both systolic and diastolic pressure were taken and recorded in Section M of the questionnaire. The average of the two readings was calculated, recorded and entered into the database. Appendix B shows the methodology for blood pressure measurements.
Table 2 – Arm Circumference and Cuff Size Arm Circumference Cuff Size A 17-22 cm Small (Children) B 23-33 cm Adult C 34-42 cm Large Adult
5.2 Anthropometry Anthropometry reflects both health and nutritional status and predicts performance, health and survival10 . It represents a portable, universally applicable, inexpensive and non-invasive techniques for assessing the size, proportions and composition of the human body. The anthropometry indices measured in this survey were body weight, height and waist circumference. Appendix B shows the standard operating procedure for anthropometric data collection.
5.3 Physical Activity Questions on physical activity were adopted from WHO`s Global Physical Activity Questionnaire (GPAQ) 7. The physical activity questions comprised of three components; • Activity At Work, • Travel To and From Places • Recreational Activities.
Interviewers were guided by a list of different types of physical activities based on the level of intensity which can be classified into moderate and vigorous activities (AppendixC) 11.
5.4 Dietary Assessment This assessment measures food consumption pattern or estimates the intake of nutrients or non- nutrients. The 24-hour dietary recall and Food Frequency Questionnaire (FFQ) were selected as the dietary assessment methods for this survey.
5.4.1 24-Hour Dietary Recall In this survey, the 24-hour dietary recall aimed to provide a complete record of all foods and drinks consumed on the previous day, from midnight to midnight. Similar to the Phase 1 of the 2nd NHANSS, 33 this methodology was used for its speed and ease of implementation, cost effectiveness and, being the most feasible and appropriate in providing detailed dietary and nutrient information for our sample size 12.
Well-trained interviewers are crucial because most of the dietary information was collected by asking probing questions. All appointed dietitians and nutritionists undertook intensive training on the correct procedures for conducting 24-hour dietary recalls. All interviewers are familiar about foods and drinks available in the marketplace and about preparation practices, including prevalent regional or ethnic foods.
Multiple pass method was employed where respondents were required to adequately describe the foods and drinks, names of the foods or drinks, brand names where necessary, preparation methods, recipes, and estimated amounts consumed12. In this method, dietary intake is reviewed more than once in an effort to retrieve missed eating occasions and foods. At the end of the interview, the trained interviewer would review the records with the subject, clarify the entries and, probe for the missing foods and drinks. The young and old, male respondents and husbands were assisted in recalling their food intake by parents/caregivers, family members and wives respectively.
Actual utensils such as different sizes of plates, bowls, glasses, cups, and spoons were provided during the interview to aid the participants in estimating food portion sizes. A food model album containing pictures of commonly consumed foods with different portion sizes was also used as guide for interviewers and respondents to estimate the quantity of food consumed. A list of commonly consumed foods with portion sizes and weight was compiled in addition to the food model album. Dietary data were recorded into section O of the questionnaire booklet (Appendix A). The completed 24-hour dietary recall data were checked and verified by principal investigators upon completion of the interview on the same day.
A second 24-hour diet recall was carried out on at least 10% of the sample population within seven to fourteen days of the first recall. The purpose was to assess for any variation in the dietary intake within and between the participants. Selected participants were identified at registration and given an appointment at the end of the first diet recall interview. The second recall was scheduled for a weekday if their first recall was a weekend day and vice versa. Replacement appointments were made for second recall if participants did not turn up for their appointment.
5.4.2 Food Frequency Questionnaire A short food frequency questionnaire (FFQ) was designed to provide qualitative and quantitative information about food consumption patterns. The FFQ was assessed by a multiple response in which respondents were asked to estimate how often a particular food or beverage was consumed. In the survey, five options were provided ranging from ‘rarely-never’, ‘x times per month’, ‘x times per week’ to ‘x times per day’ including an option for ‘Don’t Know’. Respondents were asked to choose one of these options. A total of eleven foods and beverages of particular interest in the population were incorporated in the questionnaire. This includes fruits, vegetables, sugar-sweetened beverages, instant drinks, coconut milk, Malay ‘kuih’, fried foods including fast foods, ‘nasi katok’, fat in poultry (chicken tails, wings and/or skin), instant noodles and ‘keropok’. Supplementary questions were included to ascertain the frequency of ‘meals eaten that were not prepared at home’, the frequency of breakfast, the ‘usual’ type of milk consumed and the ‘most often used’ cooking oil at home.
34 6 Data Management
Databases that had been prepared earlier for entry and analysis were: • Database 1 - for questions on Section A to N and P • Database 2 - for dietary data from 24-hour dietary recalls on Section O The master file database was created using SPSS version 15 for Windows8 , which contains information on demography, socio-economic status, smoking status, physical activity, health status, body image, food supplements, food frequencies, anthropometric data and the biochemical results. FoodWorks® Professional Edition (Version 2009) 9 software uses the AUSNUT database for nutritional analysis on the 24-hour dietary recalls. Results of nutrient analysis were then merged with the master file database for further analysis. However, nutritional information on dietary recall is limited to information available in the food database. This resulted in the use of substitute ingredients to represent commonly consumed food in Brunei Darussalam and thus may affect the macro- and micro-nutrients analysis.
6.1 Data Entry and Cleaning for Database 1 These were carried out by experienced staff from the Statistics Unit and supervised by Head of the Statistics Unit of Research and Development Section, Department of Policy and Planning of the Ministry of Health. Prior to data entry, all questionnaires were verified again. Data was then entered into the master file database 1. For the purpose of familiarisation and minimising errors, initial data entry for over 10% of the questionnaires were carried out by a pair of staff; with one person reading the written data to the other paired person entering data. This further helps in verifying the recorded data. Weekly data analysis was done to detect patterns of errors in data entry and questions interpretations to provide early feedback on corrective measures. In addition, patterns in data were also cross-checked with other similar and/or related questions to ensure consistency.
6.2 Dietary Data Entry and Cleaning for Database 2 Data of 24 hour diet recalls were entered and cleaned by dietitians/nutritionists using FoodWorks® 2009 Professional Edition (Version 9.0)9. A total of 284 local foods and recipes had been developed using foods available in the FoodWorks® 2009 Professional Edition (Version 9.0), which included those that had been used in Phase 1 of the 2nd NHANSS. Cleaned data from FoodWorks® was then converted into Microsoft Access software for final cleaning and to be merged with Database 1.
7 Data Analysis
Descriptive statistics were used to assess data from all sections of the questionnaire. A WHO macro using WHO growth standards to assess children (5-18 years old) anthropometric data by z-scores was used. The Multiple Source Method program estimated usual population intakes13 with the data from the second diet recalls. Data was analysed using SPSS version 15.0 (SPSS Inc, 2003). 35 A nurse preparing to take blood sample
Procedure for collecting blood sample
Research assistants taking waist circumference measurement from a young participant
36 8 Results
The Brunei Darussalam 2nd NHANSS Phase 2 survey was based on a target population of 4000 respondents aged from five to seventy-five years old. A total of 2184 respondents took part in the survey with a response rate of 54.6%.
8.1 Demographic Characteristics Demographic details were described as population by gender, districts, age-groups, residential status, ethnicity, religion and marital status.
8.1.1 Survey Population by Gender and District There were more female (n = 1157; 53%) than male respondents (n = 1027; 47%). The respondents from Brunei Muara were the majority with 67.7%, followed by Belait (17%), Tutong (12%) and Temburong (3.3%) as shown in Table 3. This is reflective of the general population distribution4 in the country.
Table 3 - Respondents By Gender And Districts
District Male Female Total
n % n % n % Brunei Muara 695 47.0 784 53.0 1479 67.7 Belait 176 47.4 195 52.6 371 17.0 Tutong 120 45.6 143 54.4 263 12.0 Temburong 36 50.7 35 49.3 71 3.3 Total 1027 47.0 1157 53.0 2184 100
8.1.2 Survey Population by Age-Groups Table 4 provides information on the age and sex distribution of the survey sample. The youngest respondent was 5.1 years old and the oldest respondent was 74.8 years old. The median age was 27.3 ±16.2 years for males and 30.0 ±16.1 years for females. The majority of the respondents were aged between 20-29 years (21.2%) and 30-39 years (20.3%).
Table 4 - Proportions Of Respondents In Each Category
Age (years) Male Female Total
n % n % n % 5-9 128 12.5 138 11.9 266 12.2 10-14 128 12.5 105 9.1 233 10.7 15-19 91 8.9 106 9.2 197 9.0 20-29 234 22.8 229 19.8 463 21.2 30-39 179 17.4 264 22.8 443 20.3 40-49 148 14.4 175 15.1 323 14.8 50-59 66 6.4 82 7.1 148 6.8 60+ 53 5.2 58 5.0 111 5.1 Total 1027 47.0 1157 53.0 2184 100 37 8.1.3 Survey Population by Residential Status The majority of the respondents were citizens of Brunei Darussalam (92.8%) with only a small proportion of permanent residents (7.1%) as shown in Figure 2.
Figure 2 - Residential Status
7.1% Brunei Citizen
Permanent Resident
92.8%
8.1.4 Survey Population by Ethnicity and Religion The majority of the respondents were Malay (87.2%) followed by Chinese (7%) and Others (5.8%) as shown in Figure 3.
Figure 3 - Ethnicity
5.8% 7.0%
Malay Chinese Others
87.2%
38 Respondents were mostly Muslim (88%), and the remaining respondents were Buddhist (4.1%), Christians (3.3%) and of other religious faiths (4.6%) as shown in Figure 4.
Figure 4 - Religion
4.6% 4.1% 3.3%
Muslim Christian Buddhist Others 88%
8.1.5 Survey Population by Marital Status The majority of the respondents (52.8%) were single, 43.3% were married, 2.2% were divorced and 1.7% were widowed. This is represented in Figure 5.
Figure 5 – Marital Status
2.2% 1.7%
Single Married
Divorced 43.3% 52 .8% Widowed
39 Waist circumference measurement taken from an adult participant
Research assistant taking height measurement of a male participant
Research assistant taking height measurement of a female participant
40 8.2 Socio-economic Status (Respondents Aged 18-75 Years) Socio-economic characteristics of the respondents aged 18-75 years were explored by housing status, electricity and piped water supply to the house, employment and education level, income and, food security or ability to buy food in the last 12 months.
8.2.1 Housing Status In this survey, 42.3% of the respondents were living in houses belonging to their parents, while 35.6% were living in their own houses as shown in Figure 6. In terms of respondents whose accommodation was provided by their employers, 6.2% paid rent and 4% were provided for free. Another 8.2% lived in other housing status such as those belonging to relatives or siblings.
Figure 6 - Housing Status 18-75 Years Old
42.3%
35.6%
8.2% 6.2% 4.0% 3.7%
Own House Rented Provided Provided By Provided Others Free By Employer Free By Employer With Rent Parents
8.2.2 Electricity and Piped Water Supply Most houses occupied by the respondents were supplied with electricity (99.7%) and piped water (99.6%).
41 8.2.3 Employment Status The employment status of respondents by gender is shown in Figure 7. Amongst the repondents with employment, 38.3% were employed by the Brunei Government, 21.1% were in the private sector and 5.7% were self-employed. Students made up 7.4% of the respondents. In this survey, 15.7% of the respondents were unemployed with more males (18%) than females (13.8%).
Figure 7 - Percentage Respondents 18-75 Years Old by Employment Status
0.1 Not Applicable 0 Total 0.1 Female 5.7 Male Self-Employed 5.2 6.3
Housewife 21.6
7.4 Student 7.8 6.9 21.1 Employed by Private 18.3 Sector 24.3
38.3 Employed by 33.3 Government 44.3 15.7 Unemployed 13.8 18.0
42 The parental employment status of respondents below 18 years old is shown in Figure 8, where similar findings were observed.
Figure 8 - Percentage Respondents <18 Years Old by Parental Employment Status
0.8 Don't Know 0.6 Total 1.0 Mother 2.8 Father Not Applicable 1.1 4.5 7.1 Self-Employed 5.0 9.3
Housewife 35.9
0.2 Student 0.2 0.2 17.8 Employed by Private 16.6 Sector 19.0 43.3 Employed by Government 33.7 52.9 10.1 Unemployed 6.9 13.3
43 8.2.4 Education Level Education level of respondents by gender is represented in Figure 9. Majority of respondents had attained secondary level education (Form 1 to 5, equivalent to current education system Year 7 to 11) with 55.3%. Tertiary education was achieved in 10.4% of the respondents and only 3.3% had no formal education.
Figure 9 – Percentage Respondents 18-75 Years Old by Education Level
0.1 Not Applicable 0.1 Total 0 Female 10.4 Male Degree-PhD 11.3 9.3 10.7 A-Level/HND 10.6 10.8
10.9 Technical/Vocational 8.3 14.1 55.3 Secondary 54.2 56.5 9.4 Primary 10.4 8.2 3.3 No formal education 5.1 1.1
44 The education level of parents for respondents aged below 18 years old is shown in Figure 10, which shows a similar pattern as in Figure 9.
Figure 10 – Percentage Respondents <18 Years Old by Parental Education
3.8 Don't Know 2.7 Total 4.8 Mother 2.2 Not Applicable 1.0 Father 3.5 7.5 Degree-PhD 7.0 8.0 6.8 A-Level/HND 6.4 7.2 8.0 Technical/Vocational 7.0 8.9 60.1 Secondary 61.2 58.9 10.1 Primary 12.5 7.8 1.5 No formal education 2.2 0.8
45 8.2.5 Income Level Figure 11 shows the monthly income level of respondents. The highest proportion of respondents earned between B$1000 to B$1999 (27.8%), with a minority earning more than $4000 per month (4.3%). Of the B$1000 to B$1999 income group, 33% are males and only 23.5% are females.
Figure 11 - Percentage Respondents 18-75 Years Old by Monthly Income
33.0 30.8 Male Female Total 27.8
25.3 23.5
18.7 17.0 15.6 15.5 14.4
11.5 11.7 9.8 10.6
6.8 7.2 5.6 4.6 3.8 4.3 2.2 0.1 0.1 0.0
<$600 $600-$999 $1000-$1999 $2000-$2999 $3000-$3999 ≥$4000 Not Applicable Don't Know
The total parental monthly income of respondents below 18 years old is represented in Figure 12. It shows that the largest proportion of parents earned between B$1000-B$1999 per month (27.3%) with 8.3% earning less than $600 per month.
Figure 12 - Percentage Respondents <18 Years Old by Total Parental Monthly Income
27.3
18.8 16.9 13.7 10.5 8.3
1.1
<$600 $600-$999 $1000-$1999 $2000-$2999 $3000-$3999 ≥$4000 Not Applicable
46 8.2.6 Food Security All respondents were enquired about food security over the preceding 12 months. However, only data for respondents aged 18-75 years old were analysed. Respondents were asked whether there was any period of time that they had ran out of food and could not afford to buy more. As shown in Figure 13, the majority (92.6%) did not experience food insecurity. But 8% of the respondents did report some problems.
Figure 13 – Percentage Respondents Age 18-75 Years Old on Food Security
91.3 93.7 92.6
Male Female Total
8.7 6.3 7.4
NO= Food Insecure YES = Food secure Note: ‘No’ means ran out of food and could not afford to buy more in last 12 months
8.3 Smoking Status The smoking status in this survey was determined from questions on current smoking habits, daily smoking habits, age when smoking had started and stopped, number of cigarettes or tobacco products smoked each day, duration since smoking cessation and the use of smokeless tobacco. During this survey period, the use of e-cigarette was not captured. 8.3.1 Percentage Smoking Habits Amongst Respondents (19-75 Years Old)
Figure 14 – Percentage Smoking Habits Amongst Respondents 19-75 Years Old
18.4 Currently Smoke 4.0 35.5
15.9 Smoke Daily 3.3 30.9
10.2 Ever Smoke Daily 3.1 18.7
5.1 Currently Smokeless 6.6 Tobacco 3.2 Total Female 0.8 Male Smokeless Tobacco Daily 1.1 0.4
47 The prevalence of smoking was 18% in this survey, with almost ten times more males (35.5%) than females (4.0%) as shown in Figure 14. Daily smoking was reported in 15.9% of those who are current smokers with more males (30.9%) than females (3.3%).
The use of smokeless tobacco such as snuff, chewing tobacco and betel was reported in 5.1% ofthe respondents. It was observed that twice as many females (6.6%) than males (3.2%) reported the use of smokeless tobacco. However, the use of smokeless tobacco daily was much less frequent at 0.8%, with more females (1.1%) than males (0.4%).
8.3.2 Period When Smoking Commenced and Ceased
Table 5 – Age When Smoking Commenced and Ceased [≥19 years (n=1524)] Male Female Total n Median SD n Median SD n Median SD Age started smoking daily 216 18.0 5.4 27 18.0 6.6 243 18.0 5.5 (years) Years ago started 216 13.6 9.5 27 13.1 13.4 243 13.5 9.9 smoking Age stopped smoking daily 128 28.5 9.9 26 25.5 14.5 154 28.0 10.8 (years) Years ago 128 8.1 10.1 26 3.6 11.2 154 6.7 10.3 stopped smoking Cigarettes 214 10.0 7.3 25 4.0 4.9 239 9.0 7.2 smoked per day
Few respondents reported smoking hand-rolled cigarettes or pipes (n=3 and n=2, respectively).
In this survey, the median age when smoking commenced was 18 ± 5.5 years as shown on Table 5. The median age at the cessation of smoking was 28 ±10.8 years old. This was noted to be at an older age for males at 28.5 ± 9.9 years compared to females at 25.5 ± 14.5 years. The median number of cigarettes smoked per day was 9 ±7.2 sticks with more males smoking 10 ± 7.3 sticks than females at 4 ± 4.9 sticks.
The survey found only few respondents (n=10) aged below 19 years old reported to be currently smoking. Hence the results are not represented here. It was also noted that the youngest daily smoker in the survey respondents was a 12.6 year old female while the oldest daily smoker was a 72.8 year old male.
48 8.4 Physical Activity In this survey, levels of physical activity were assessed by activity at work, travel to and from places, recreational activities and duration of time spent in daily resting and on television viewing. Appendix C shows the types of sporting activities categorised as vigorous and moderate intensity.
Table 6: Percentage Respondents Not Meeting Brunei Recommendations on Moderate Physical Activity for Health (<150 minutes/week) Males Females Total Age group n % n % n % 19-59 172 26.8 319 41.5 491 34.8 60+ 25 47.2 24 41.4 49 44.1 Total 197 28.3 343 41.5 540 35.5
In this survey, 35.5% of the respondents did not meet the recommended duration of moderate physical activity in a week (Table 6). The median time spent for physical activity was 45.0 ±140.9 minutes per day (Table 7).
8.4.1 Physical Activity at Work Amongst the respondents, 42.3% engaged in work-related physical activity and they reported a mean time of 42.6 ±104.5 minutes per day spent on this activity.
8.4.2 Travel to and from Places In this survey, 36.5% reported to have continuously travelled by walking or using bicycle from place to place for at least 10 minutes. They reported a mean time of 7.9 ±25.8 minutes per day for this type of activity.
8.4.3 Recreational Physical Activity In terms of recreational physical activity, 70.7% engaged in such activities with a reported mean time of 45.9 ± 70.8 minutes per day. This activity was performed more amongst males (76.4%) than females (66.9%). The mean time spent in these activities was longer amongst males (48.7 ± 66.5 minutes) than females (43.6 ± 74.1 minutes per day) as shown in Table 7.
8.4.4 Resting and Televison Viewing Resting is defined as time usually spent by respondents on sitting, resting or reclining on a typical day but excluded time watching television and sleeping. As shown in Table 7, the median duration spent resting was 240 ± 153.1 minutes per day.
However, the median time spent viewing television by males was higher (120 ± 116.0 minutes per day) than females (90 ± 105.6 minutes per day).
Overall, the total sedentary time resting and watching television was at a median of 360 ± 179.1 minutes per day with males spending 360 ± 385.7 minutes per day and females spending 330 ± 176.9 minutes per day.
49 1 1 9 5 D D D S S S 85 .5 25 .8 70 .8 153 . 179 . 140 . 104 . 4 3 4 k y y e .9 ea n ea n ea n e 7 l d a 96 .4 45 .9 42 .6 110 . 258 . 368 . M M M /d a w a / / n n n To t 0 0 0 inute s di a 0 0 di a di a inute s e e e 45 .0 17 .1 M 110 . 240 . 360 . M inute s M M M M 7 7 0 7 7 9 0 n n n 15 1 15 1 15 1 15 1 15 1 15 1 15 1 1 2 9 D D D S S S 12 .1 74 .1 92 .6 80 .8 124 . 153 . 176 . 6 6 9 k y e y .6 ea n ea n ea n e 4 86 .6 43 .6 38 .3 d a 105 . 248 . 353 . M M M w /d a / / n n n 0 Fe ma le inute s inute s .6 0 0 di a di a di a inute s 8 M 24 0 M e e e 90 .0 34 .2 M 330 . M M M
n n n 82 6 82 6 82 2 82 2 82 6 82 6 82 6
3 2 1 2 D D D S S S 35 .4 90 .5 66 .5 157 . 180 . 117 . 152 . 1 0 7 9 k y y e ea n ea n ea n e 11 .7 48 .7 47 .7 d a 108 . M M 116 . 385 . 269 . M /d a w / le / a n n n M 0 0 0 inute s di a 0 0 di a di a inute s inute s e e e 55 .7 21 .4 M 360 . 120 . 240 . M M M M M n n n 68 8 68 8 69 3 69 1 69 1 69 1 69 1
Physical Activity and Sedentary Behaviour Amongst Respondents (19 years above) y i t y me – ted ted ted
i v i t a 7 T l l a l a t i pent
v c t i le r e r e S c - - A ar y b ing t l A a
a it t l T y e n ork a port i c Tim e W s e d S i c iour y nsport-r e s S v h y a ting / s tching TV P h Tr a a P ota l T Se denta r Beh Re s W
50 Photo showing food model album and different types of utensils used as guidance to estimate quantities of food intake
Respondents being interviewed by investigators
Respondent being interviewed by dietitian for a 24-hour food recall
51 8.5 Health Status and Illness Amongst Respondents Aged 19 Years and Above (n=1524) Self-reporting on health status was determined by questions on history of hypertension including when blood pressure was last measured and treatment received. Similar assessments were also made on history of diabetes and dyslipidaemia. Other chronic medical conditions as informed by the doctor or health worker in the last 12 months were also enquired (Appendix D).
8.5.1 History of Hypertension In this survey, 64.0% of the respondents have had their blood pressure checked by a doctor or health worker within the last 12 months as shown in Table 8. Conversely, 9.2% reported that their blood pressure had never been checked. However, 5.2% reported that their last blood pressure measurement was five or more years ago.
Amongst the respondents, 19.0% reported that they have been told they had hypertension by a doctor or health worker in the last 12 months prior to the survey. In terms of the management of hypertension in this group of respondents (19.0%), 87.5% were on anti-hypertensive medications (tablets), 59.2% on dietary modifications and 65.7% were advised to lose weight, 19.0% were advised to stop smoking and 80.6% were advised to start or increase exercise activity. It is reported that 4.5% have seen a traditional healer and 5.2% were taking traditional remedy for the management of hypertension.
Table 8 – History of Hypertension
Male Female Total Blood pressure last measured n % n % n % ≤12 months ago 423 60.8 553 66.8 976 64.0 1-5 years ago 156 22.4 165 19.9 321 21.1 ≥5 years ago 46 6.6 34 4.1 80 5.2 Total had their blood pressure measured 625 89.8 752 90.4 1377 90.4 Never 68 9.8 72 8.7 140 9.2
Told high blood pressure / 133 21.3 156 20.7 289 19.0 hypertension in the last 12 months
Currently receiving treatment/advice Tablets 112 84.2 141 90.4 253 87.5 Special prescribed diet 75 56.4 96 61.5 171 59.2 Weight loss 95 71.4 95 60.9 190 65.7 Stop smoking 46 34.6 9 5.8 55 19.0 Exercise 114 85.7 119 76.3 233 80.6
Seen traditional healer 6 4.5 7 4.5 13 4.5 Taking traditional remedy 8 6.0 7 4.5 15 5.2
*Some respondents did not know the response therefore they are not included in table above.
52 8.5.2 History of Diabetes Self-reporting of diabetes was determined by enquiring testing for blood glucose, history of diabetes and its management over the preceding twelve months as per Appendix A. In addition, female respondents were asked about diabetes during pregnancy and their diabetes status after delivery.
As shown in Table 9, 43.9% of respondents reported to have had their blood glucose checked and 17.2% were told that they have diabetes. Amongst those on treatment for diabetes, 14.8% were on insulin injections, 78.3% were on oral hypoglycaemics (oral drugs), 70.4% were on dietary modifications, 72.2% were advised to lose weight, 24.3% were advised to stop smoking and 80.9% were advised to start or increase their physical activity. In this survey, 5.2% reported to have seen a traditional healer and 4.3% were taking herbal or traditional remedy for the management of diabetes.
Amongst females, 5% reported that they were informed that they had high blood sugar during pregnancy. Out of these group 29.8% reported persistent high blood sugar after birth.
Table 9 – Status on Blood Glucose Testing and Diabetes Male Female Total n % n % n % Blood glucose last measured 288 41.4 381 46.0 669 43.9 ≤12 months
Told high blood glucose/ 52 18.0 63 16.5 115 17.2 diabetes in last 12 months
Currently receiving treatment/advice Insulin injection 5 9.6 12 19.0 17 14.8 Oral drugs 38 73.1 52 82.5 90 78.3 Special prescribed diet 38 73.1 43 68.3 81 70.4 Weight loss 33 63.5 50 79.4 83 72.2 Stop smoking 23 44.2 5 7.9 28 24.3 Exercise 40 76.9 53 84.1 93 80.9
Seen traditional healer 4 7.7 2 3.2 6 5.2 Taking traditional remedy 4 7.7 1 1.6 5 4.3
First told during pregnancy - - 57 5.0 - -
High blood glucose after birth - - 17 29.8 - -
*Some respondents did not know the response hence is not included in table above.
53 8.5.3 History of Dyslipidaemia Self-reporting of dyslipidaemia was determined by enquiring testing for blood cholesterol, history of dyslipidaemia and its management over the preceding twelve months as per Appendix A.
In this survey, 44.8% reported to have had their blood cholesterol checked, and 37.1% were told to have dyslipidaemia as shown in Table 10. Amongst those on treatment, 76.7% indicated that they were on oral treatment (tablets), 66% were on dietary modifications, 61.7% were advised to lose weight, 15.0% were advised to stop smoking and 81.4% were advised to start or increase physical activity. Only 0.8% reported to have seen a traditional healer and 3.2% were taking herbal or traditional remedy for the management of dyslipidaemia.
Table 10 – Status of Blood Cholesterol Testing and Dyslipidaemia Male Female Total n % n % n %
Blood cholesterol last 301 43.2 381 46.0 682 44.8 measured ≤12 months
Told had dyslipidaemia 121 40.2 132 34.6 253 37.1
Currently receiving treatment/advice Tablets 94 77.7 100 75.8 194 76.7 Special prescribed diet 78 64.5 89 67.4 167 66.0 Weight loss 83 68.6 73 55.3 156 61.7 Stop smoking 32 26.4 6 4.5 38 15.0 Exercise 102 84.3 104 78.8 206 81.4
Seen traditional healer 0 0 2 1.5 2 0 .8 Taking traditional remedy 4 3.3 4 3.0 8 3 .2
*Some respondents did not respond and are not included in table above.
54 Participant being interviewed by a dietitian
Photo showing food model containing pictures of commonly-eaten foods and different types of utensils used as guidance to estimate the amount of food consumed
Dietitian using food and reference file to get measurements of a participant’s food intake
55 8.6 Anthropometric Measurements Weight, height and waist circumference made up the anthropometric indicators in the survey. Although in recent years, there had been two previous attempts to interpret the BMI cut-offs for Asian and Pacific populations14, the WHO Expert Consultation 15 concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> 25 kg/m2). However, the cut-off point for observed risk varies from 22 to 25 kg/m2 in different Asian populations and for the high risk it varies from 26 to 31 kg/m2. The expert consultants, therefore recommended that the current WHO BMI cut-off points should be retained as the international classification.
8.6.1 Stunting Amongst the 5-19 Years Old Moderate stunting is defined as more than two standard deviations below median height for age on WHO growth standards 16. As shown in Figure 15, moderate stunting was 15.6%. The largest age group with moderate stunting was the 15-19 years old (21.1%), followed by the 5-9 years old ( 14.7%) and the 10-14 years old (12.9%).
Figure 15 – Percentage of Moderate Stunting Amongst 5-19 Years Old (n=663)
24.0 21.1 18.6
15.7 15.5 15.3 15.6 14.1 14.7 12.5 13.3 12.9
5 to 9 10 to 14 15 to 19 Total Age (Years Old) Male Female Total
Severe stunting was seen in 2.3% of the respondents (Figure 16) with more severe stunting observed amongst females at 3% compared to males at 1.5%.
The largest age group with severe stunting was amongst the 5-9 years old (3.4%), followed by the 15-19 years old (1.8%) and the 10-14 years old (1.3%). Overall, there appeared to be more severe stunting amongst the females in all age groups apart from the 10-14 years of age where there were no reported cases.
56 Figure 16 – Percentage of Severe Stunting Amongst 5-19 Years Old (n=663)
5.1
3.4 3.5 3.0
2.3 2.3 1.8 1.6 1.5 1.3
5 to 9 10 to 14 15 to 19 Total Age (Years Old) Male Female Total
8.6.2 BMI-for-age Amongst the 5-19 Years Old Table 11 shows the findings for BMI-for-age on the following parameters; • moderate wasting which was defined as lower than two standard deviations below median BMI-for-age on WHO growth standards 16 ; • severe wasting which was defined as lower than three standard deviations below median BMI-for-age 16 ; • overweight which was defined as more than one standard deviation above median BMI-for-age on WHO growth standards 16 ; • obese which was defined as more than two standard deviations above median BMI-for-age16 .
Only 0.2% of the respondents were found to have severe wasting. However, moderate wasting was identified in 4.2%. The highest rates of moderate wasting were found in older adolescents at 5.6% in the 15-19 year old age group. These rates were higher for males than females in every age group.
In this age category, 33.5% were found to be overweight. Overweight was highest amongst the 10-14 years old (41.6%), followed by the 15 to 19 years old (30.4%) and 5 to 9 year old (28.3%). The lowest prevalence of overweight was amongst the 5 to 9 year old females with 26.3% while the highest prevalence was amongst the 10 to 14 year old males with 46.9%.
In terms of obesity, 18.2% were obese. The highest prevalence of obesity was in the 10 to 14 years old (23.6%) followed by the 5 to 9 years old (15.8%) and 15 to 19 year old (14.3%). The highest prevalence of obesity was amongst the males aged 10 to 14 year old with 28.9% while females aged 5 to 9 year old had the lowest prevalence of 12.4%.
These findings indicate that overweight and obese individuals in the younger age groups pose a major problem in this country. Further study and early intervention will be required to address this issue. 57 Table 11 – Anthropometric Measurements Among 5-19 Years Old (n=659)
Indicator Nutritional Age Male Female Total status (years) n % n % n %
BMI-for- <-2SD Moderate 5-9 7 5.5 5 3.6 12 4.5 age wasting 10-14 4 3.1 3 2.9 7 3.0 15-19 6 8.0 3 3.5 9 5.6 Total 17 5.1 11 3.4 28 4.2
<-3SD Severe 5-9 0 0 0 0 0 0 wasting 10-14 1 0.8 0 0 1 0.4 15-19 0 0 0 0 0 0 Total 1 0.3 0 0 1 0.2
>+1SD Overweight 5-9 39 30.5 36 26.3 75 28.3 10-14 60 46.9 37 35.2 97 41.6 15-19 24 32.0 25 29.1 49 30.4 Total 123 37.2 98 29.9 221 33.5
>+2SD Obese 5-9 25 19.5 17 12.4 42 15.8 10-14 37 28.9 18 17.1 55 23.6 15-19 12 16.0 11 12.8 23 14.3 Total 74 22.4 46 14.0 120 18.2
*Few 19 year old respondents included due to age cut-off used by the World Health Organisation macro for analysing anthropometric data for 5-19 years old.
8.6.3 Anthropometric Measurements Amongst ≥ 19 Years Old (n=1524) The mean weight, height, waist circumference and body mass index by gender in the survey is shown in Table 12.
8.6.3.1 Mean Weight The mean weight was 68.0 ± 17.2 kg with a higher mean weight in males at 74.1 ± 18.0 kg compared to females at 62.9 ± 14.6 kg. The heaviest mean weight was 70.2 ± 16.8 kg in the 30-39 years old with a higher mean weight in males (78.0 ± 17.8 kg) compared to females (65 ± 13.9 kg). Whereas, the least heavy age group were amongst 60 years old and above at 62.6 ± 14.3 kg, with the lowest mean weight for males at 68.1 ± 13.2 kg and females at 57.6 ± 13.4 kg.
8.6.3.2 Mean Height The mean height was 1.58 ± 0.09 metres. In terms of gender, the mean height for males was 1.65 ± 0.06 metres and, the females was 1.52 ± 0.06 metres. 58 8.6.3.3 Mean Waist Circumference The mean waist circumference was 87.2 ± 14.1 cm. The males had a wider mean waist circumference of 90.9 ± 14.9 cm compared to the females with 84.0 ± 12.5cm. Amongst the males, the widest mean waist circumference was in the 40-49 years old (93.9 ± 15.0 cm) while the smallest mean waist circumference was in the 19-29 years old (86.8 ± 16.3 cm). Amongst females, the 50-59 years old had the widest mean waist circumference (88.1 ± 11.6 cm) and the 19-29 years age (80.2 ± 14.4 cm) had the smallest mean waist circumference.
Table 12 - Anthropometric Measurements Among ≥19 Years Old (n=1524)
Age / Male Female Total years n Mean SD n Mean SD n Mean SD 19-29 250 72.1 20.0 249 60.8 17.5 499 66.5 19.6 30-39 179 78.0 17.8 264 65.0 13.9 443 70.2 16.8 40-49 148 76.5 17.7 175 63.8 11.7 323 69.6 16.1 Weight (kg) 50-59 66 71.0 10.8 82 63.9 11.4 148 67.1 11.7 60+ 53 68.1 13.2 58 57.6 13.4 111 62.6 14.3 Total 696 74.1 18.0 828 62.9 14.6 1524 68.0 17.2
19-29 250 1.65 0.06 249 1.53 0.06 499 1.59 0.09 30-39 179 1.66 0.06 264 1.53 0.06 443 1.58 0.09 40-49 148 1.64 0.06 175 1.53 0.06 323 1.58 0.08 Height (m) 50-59 66 1.64 0.06 82 1.52 0.05 148 1.57 0.08 60+ 53 1.62 0.07 58 1.48 0.06 111 1.55 0.10 Total 696 1.65 0.06 828 1.52 0.06 1524 1.58 0.09
19-29 250 86.8 16.3 249 80.2 14.4 499 83.5 15.7 Waist 30-39 179 93.6 14.1 264 85.0 11.2 443 88.5 13.1 Circum- 40-49 148 93.9 15.0 175 85.0 10.4 323 89.1 13.4 ference 50-59 66 92.5 9.8 82 88.1 11.6 148 90.1 11.0 (cm) 60+ 53 90.8 11.5 58 87.2 12.6 111 89.0 12.1 Total 696 90.9 14.9 828 84.0 12.5 1524 87.2 14.1
19-29 250 26.2 7.0 249 25.9 7.0 499 26.1 6.9 30-39 179 28.4 5.8 264 27.7 5.6 443 28.0 5.7 40-49 148 28.2 5.9 175 27.4 4.8 323 27.8 5.4 BMI (kg/m2) 50-59 66 26.6 4.0 82 27.8 4.7 148 27.2 4.5 60+ 53 25.8 4.6 58 26.1 5.2 111 26.0 4.9 Total 696 27.2 6.1 828 27.0 5.8 1524 27.1 6.0
59 8.6.3.4 Mean Body Mass Index (BMI-kg /m2) The overall mean BMI was 27.1 ± 6.0 with the mean BMI of 27.2 ± 6.1 for males and 27.0 ± 5.8 for females. These figures have increased compared to the 1997 National Nutrition Status Survey 2 where the mean BMI was 24.9 for males and 24.7 for females. The highest mean BMIs were amongst the 30- 39 year old males (28.4 ± 5.8) and 50-59 year old females (27.8 ± 4.7). Elderly male aged 60 years and above had the lowest mean BMI of 25.8 ± 4.6. In contrast, the females had the lowest BMI of 25.9 ± 7.0 in the younger age group of 19-29 years old.
8.6.3.5 Body Mass Index (BMI) Categories Underweight, overweight and obesity in adults are categorised based on the World Health Organisation international BMI classification shown in Table 13. A healthy BMI is defined as 18.5-24.9 kg/m2.
8.6.3.5.1 Underweight The prevalence of underweight (BMI < 18.5kg/m2) was 5.1%. A higher proportion of underweight was seen amongst the 19-29 years old group at 10.2%. There were more females (12%) who were underweight compared to males (8.4%). The least underweight age category was seen amongst the 40-49 years old group with a prevalence of 1.5%.
8.6.3.5.2 Overweight The prevalence of overweight (BMI 25-29.9) was 33.4%. Amongst males, the 50-59 years group had the highest proportion of overweight at 43.9%. In the females, this was seen in the 40-49 years old group with a prevalence of 41.1%. The prevalence of overweight in both gender groups has showed minimal changes since the 1997 National Nutritional Status Survey2 where 33.8% of males and 31.3% females were found to be overweight.
8.6.3.5.3 Obesity The WHO BMI categories for obesity are further divided into three classes: Obese Class I (BMI 30- 34.9), Obese Class II (BMI 35-39.9) and Obese Class III (BMI≥40)10, 15, 17.
The overall prevalence of obesity amongst respondents was 27.1%. The majority were in Obese Class I with a prevalence of 17.5% followed by Obese Class II with 6.6% and Obesity Class III with 3.0%. The obesity rates have doubled since the 1997 National Nutritional Status Survey which reported an obesity prevalence of 12%, with an increase of about 1.2% annually. The present survey indicates that the prevalence of obesity is almost similar in both the females with 27.3% and males with 27.1%.
The age group 50-59 years old showed that a higher proportion of females at 24.4% compared to males at 21.2% were classified as Obese Class I. In Obese Class II, the highest prevalence of obesity amongst females were aged 19-29 years old (8.8%). In males, Obese Class II were reported to be the highest amongst aged 30-39 years old (10.6%). Whereas for Obese Class III, the highest prevalence of obesity was amongst males aged 40-49 years old (5.4%) and, females aged 19-29 years old (2.8%). 60 Table 13 - Proportion Of Respondents ≥19 Years Old Across BMI Categories (n=1524) BMI category Age Male Female Total n % N % n % Underweight 19-29 21 8.4 30 12.0 51 10.2 2 BMI ≤ 18.5 kg/m 30-39 8 4.5 6 2.3 14 3.2 40-49 3 2.0 2 1.1 5 1.5 50-59 2 3.0 1 1.2 3 2.0 60+ 3 5.7 1 1.7 4 3.6 Total 37 5.3 40 4.8 77 5.1
Normal 19-29 109 43.6 106 42.6 215 43.1 2 BMI 18-24.9 kg/m 30-39 37 20.6 82 31.0 119 26.9 40-49 42 28.4 58 33.2 100 31.0 50-59 20 30.4 23 28.1 43 29.0 60+ 23 43.3 24 41.5 47 42.4 Total 231 33.1 293 35.6 524 34.4
Overweight 19-29 60 24.0 49 19.7 109 21.8 BMI 25-29.9 kg/m 2 30-39 77 43.0 93 35.2 170 38.4 40-49 58 39.2 72 41.1 130 40.2 50-59 29 43.9 33 40.2 62 41.9 60+ 16 30.2 22 37.9 38 34.2 Total 240 34.5 269 32.5 509 33.4
Obese 19-29 31 12.4 35 14.1 66 13.2 (Obese Class I) 30-39 32 17.9 55 20.8 87 19.6 2 BMI 30-34.9 kg/m 40-49 29 19.6 32 18.3 61 18.9 50-59 14 21.2 20 24.4 34 23.0 60+ 10 18.9 9 15.5 19 17.1 Total 116 16.7 151 18.2 267 17.5
19-29 16 6.4 22 8.8 38 7.6 Moderate Obese 30-39 19 10.6 21 8.0 40 9.0 (Obese Class II) 40-49 8 5.4 8 4.6 16 5.0 2 BMI 35-39.9 kg/m 50-59 1 1.5 4 4.9 5 3.4 60+ 1 1.9 1 1.7 2 1.8 Total 45 6.5 56 6.8 101 6.6
19-29 13 5.2 7 2.8 20 4.0 Severe Obesity 30-39 6 3.4 7 2.7 13 2.9 (Obese Class III) 40-49 8 5.4 3 1.7 11 3.4 2 BMI > 40 kg/m 50-59 0 0 1 1.2 1 0.7 60+ 0 0 1 1.7 1 0.9 Total 27 3.9 19 2.3 46 3.0 OBESE TOTAL TOTAL 188 27.1 226 27.3 414 27.1
61 8. 7 Body Image Questions on body image included questions on what weight status they considered themselves to be, how they felt about their current weight and whether they were on a weight reducing diet.
Table 14 shows that 14.7% considered themselves to be ‘underweight’, 40.6% rated their weight as ‘acceptable’, 39.2% thought they were ‘overweight’ while only 3.2% thought that they were ‘very overweight’. In general, 16.2% of males considered themselves to be ‘underweight’ while 41.4% of females considered themselves to be ‘overweight’. However, male and female who had considered themselves to be ‘very overweight’ were almost similar at 3% and 3.3% respectively.
When asked about how they felt about their weight, 13.5% reported ‘very satisfied’, 34.7% ‘somewhat satisfied’ and 48.8% ‘not satisfied’ with their current weight . Only 1.7% of the respondents indicated ‘don’t care’ when asked about their weight.
Amongst the survey respondents, 22.4% admitted to be on a weight loss diet. This was reported more in females (24.2%) than males (20.4%).
Table 14 - Self-Rated Weight Status Among Respondents (n=2184) Consider themselves Male Female Total n % N % n % Underweight 5-9 years 46 35.9 41 29.7 87 32.7 10-14 years 25 19.5 14 13.3 39 16.7 15-18 years 14 18.7 20 23.3 34 21.1 19-59 years 72 43.4 77 10.0 149 10.5 60 and above 9 5.4 4 6.9 13 11.7 Total 166 16.2 156 13.5 322 14.7 Normal 5-9 years 56 43.8 66 47.8 122 45.9 10-14 years 62 48.4 54 51.4 116 49.8 15-18 years 38 50.7 31 36.0 69 42.9 19-59 years 246 38.3 265 34.4 511 36.2 60 and above 28 52.8 40 69.0 68 61.3 Total 430 41.9 456 39.4 886 40.6 Overweight 5-9 years 19 14.8 18 13.0 37 13.9 10-14 years 36 28.1 33 31.4 69 29.6 15-18 years 19 25.3 32 37.2 51 31.7 19-59 years 288 44.8 382 49.6 670 47.4 60 and above 15 28.3 14 24.1 29 26.1 Total 377 36.7 479 41.4 856 39.2 Very 5-9 years 1 0.8 0 0 1 0.4 Overweight 10-14 years 2 1.6 1 1.0 3 1.3 15-18 years 1 1.3 2 2.3 3 1.9 19-59 years 26 4.0 35 4.5 61 4.3 60 and above 1 1.9 0 0 1 0.9 Total 31 3.0 38 3.3 69 3.2 No 5-9 years 2 1.6 4 2.9 6 2.3 Consideration 10-14 years 2 1.6 3 2.9 5 2.1 15-18 years 3 4.0 0 0 3 1.9 19-59 years 10 1.6 9 1.2 19 1.3 Total 17 1.7 16 1.4 33 1.5
*Some respondents did not know the response therefore they are not included in table above. 62 Some of the survey team members involved during the survey
Survey team members at the Department of Health Services, Temburong District
Participant using sign language to answer survey questions
63 8.8 Food and Nutrient Intake Dietary assessment was undertaken for all survey respondents via questions on: • 24-hour dietary recall • Short food frequency questions focusing on fruit, vegetable, eating meals outside the home or not prepared at home, frequency of breakfast, intake of beverages including milk, sugar-sweetened drinks, instant drinks and use of oil and coconut milk. Intake of “Malay kuih” or dessert, fried food, “nasi katok,” instant noodles and snacks • Intake of food supplements
8.8.1 24-hour Dietary Recall Assessment by 24-hour dietary recall was carried out by dietitians/ nutritionists. A second recall was conducted on 10% of the respondents.
8.8.1.1 Energy Intake
Table 15 – Energy Intake Age / years old n Median Energy
kJ ±SD kcal ±SD Males 5-6 40 5777 1547 1381 370 7-9 87 6359 1734 1520 414.5 10-12 72 6544 2002.5 1564 479 13-15 68 6482 2334 1549 558 16-18 62 6086 2074 1455 496 19-59 630 7173 2355 1714 563 60+ 54 5947 1752 1421 419 Total 1013 6746 2260 1612 540 Females 5-6 44 5208 1640 1245 392 7-9 90 5418 1723 1295 412 10-12 66 5611 1911 1341 457 13-15 54 5721 1341 1367 320.5 16-18 67 5858 1924 1400 460 19-59 756 5444 1727 1301 413 60+ 59 4006 1346 957.5 322 Total 1136 5387 1749 1287.5 418
The median daily energy intakes according to age-groups are shown in Table 15. In all respondents regardless of gender, the energy intake were generally lower than RNI 18. This is not surprising as dietary intake methodologies such as 24 hour recalls capture a snapshot of what the community is consuming rather than their total usual diet and, thus may not truly reflect total dietary energy intake12. 64 The lowest median energy intake reported was recorded in males aged 5 to 6 years old with 1381 ± 370 kcal/day and in females aged 60 years and above with 957.5 ± 322 kcal/day.
On the other hand, the highest energy intakes were reported in males aged 19 to 59 years old with 1714 ± 563 kcal/day and, in females aged 16 to 18 years old with 1400 ± 460 kcal/ day.
Rice was the main energy source for all age-groups. It contributed to 19.1% of males and 18.4% of females (Figure 17). This is followed by beverages contributing to 14.5% of energy in males and 13.8% in females. Meat, noodle and noodle dishes, bread and crackers, and fish, each provide between 5.1% and 9.5% of energy while fast food and salty snacks each contributed less than 3% to the total daily energy intakes for both males and females.
These findings revealed that beverages contributed to over 10% of total energy intake which indicates a preference among Bruneians for high-calorie, sugar-sweetened beverages (Figure 17).
Figure 17 : Percentage Contribution of Energy Intake From Food Sources
2.8 Salty Snacks 2.0 2.5 Fast Food 2.9 13.8 Beverages 14.5 6.1 Fish 5.1 Female Meat 8.6 9.5 Male 6.0 Bread and Crackers 6.0 7.6 Noodles and Noodle Dishes 8.9 18.4 Rice 19.1 Food Sources Percentage (%)
65 8.8.1.2 Carbohydrate Intake
Table 16 : Carbohydrate Intake Age / years old N Carbohydrate / g % Energy from Carbohydrate median ±SD Mean (SD) Males 5-6 39 176.8 55.7 53.2 8.4 7-9 86 203.9 49.9 53.8 6.7 10-12 71 207.7 52.0 53.7 7.5 13-15 66 209.5 54.1 54.9 7.2 16-18 61 202.3 56.3 53.8 7.4 19-59 620 220.7 64.7 52.2 7.4 60+ 54 185.3 51.5 53.9 6.5 Total 997 212.8 61.7 52.8 7.3
Females 5-6 44 174.7 48.1 53.1 6.4 7-9 88 174.3 45.1 54.1 8.0 10-12 65 186.0 53.9 53.3 6.2 13-15 54 167.5 40.3 51.5 6.8 16-18 67 182.8 51.7 52.9 8.1 19-59 742 167.3 45.8 52.9 6.8 60+ 59 135.0 40.7 56.8 7.3 Total 1119 167.3 47.0 53.1 7.0
The median daily of carbohydrate intake amongst males was 212.8 ± 61.7 grams while the mean of total energy intake was 52.8 ± 7.3%. Amongst females, the median intake was 167.3 ± 47.0 g and the mean of total energy intake was 53.1 ± 7% of energy intake. Hence in all age-groups, 50-55% of energy intake were derived from carbohydrate.
Meanwhile in males, the mean percentage contribution of carbohydrate ranged from 54.9 ± 7.2 % amongst the 13 to 15 years old to 52.2 ± 7.4% amongst the 19 to 59 years old. In contrast, females aged 60 years and beyond derived the most energy (56.8 ± 7.3%) from carbohydrate foods with the least in the aged 13-15 years with 51.5 ± 6.8%.
Rice followed by beverages, were the main sources of of carbohydrate (Figure 18). It was the source of carbohydrate for 32.1% of males and, 30.6% of females while beverages was the source for 21.5% of males and 20.4% of females in this survey. The intake of noodles and noodle dishes, sugars, preserves and spreads and bread and crackers provided less than 10% each while fruit contributed to less than 5% of carbohydrates. 66 Figure 18 : Percentage Contribution Of Carbohydrate Intake From Food Sources
Sugar, Preserves, Spreads, 8. 1 Confectionary 8. 1 20.4 Beverages 21.5
4.2 Fruits 3.0 Females Males 7.4 Bread and crackers 7.2
8.1 Noodle and noodle dishes 9.0
Rice 30.6 32.1 Food Sources Percentage (%)
8.8.1.3 Protein Intake
Table 17 – Protein Intake Age / years old n Protein / g Protein Met Protein Median ±SD RNI (g) RNI (%) Males 5-6 40 54.1 13.3 23 100 7-9 85 59.0 13.4 32 97.6 10-12 71 62.7 18.9 45 87.3 13-15 67 59.2 21.7 63 46.3 16-18 62 59.6 19.5 65 38.7 19-59 618 72.0 21.6 62 69.3 60+ 54 70.2 19.8 59 68.5 Total 997 67.3 21.1 - 70.7 Females 5-6 43 48.4 12.4 23 100 7-9 89 48.7 13.6 32 93.3 10-12 66 57.8 17.9 46 68.2 13-15 53 56.6 13.2 55 56.6 16-18 65 51.5 16.2 54 44.6 19-59 744 54.6 16.4 55 48.0 60+ 59 44.1 14.8 51 28.8 Total 1119 53.6 16.1 - 54.0 67 The reported dietary protein intake according to the different age-groups are shown in Table 17. The median daily protein intake amongst those aged 5-75 years old were 67.3 ± 21.1 g in males and 53.6 ± 16.1 g in females. The range of intake for males were from 54.1 ± 13.3 g to 72.0 ± 21.6 g while in females this ranged from 44.1 ± 14.8 g to 57.8 ± 17.9 g. Protein intake were generally higher in males than females across all age groups. In terms of adequacy, 70.7% of males and 54% of females met the RNI for protein.
Amongst males, all the 5 to 6 year old respondents and the majority of the 7 to 12 year old met the RNI. For the age-groups 19 to 75 years old, 68.5% to 69.3% met the RNI. The least proportion of males meeting the RNI was in the 13 to 15 years old age group (46.3%) and the 16 to 18 years old (38.7%). Similarly all female children aged 5 to 6 years old and 93.3% of the 7 to 9 years old met the RNI. Amongst females, 68.2% of the 10 to 12 years old, 56.6% of the 13 to 15 years old, 44.6% of the 16 to 18 years old and 48.0% of the 19 to 59 years old met the RNI. While in other age groups, only 28.8% in the 60 years and above group met the RNI.
The major source of protein is derived from meat for both genders (Figure 19). This was followed by fish in 14.6% of males and 17.4% of females and, meat and meat dishes in 10.8% of males and 9.5% of females. The other food sources such as noodles and noodles dishes, rice, bread and crackers, beverages, egg and egg dishes and fast foods each contributed to less than 10% of total protein intake.
Figure 19 : Percentage Contribution Of Protein Intake From Food Sources
3.7 Fast Food 4.2 Beverages 5.3 5.2 Bread and Crackers 4.8 4.9 Noodle and Noodle Dishes 4.4 4.9 Rice 7.3 Female 7.5 Male Eggs and Egg Dishes 4.1 4.3 Fish 17.4 14.6 Meat Dishes 9.5 10.8 23.2 Meat 25.5 Food Sources Percentage (%)
68 8.8.1.4 Fat Intake The median consumption of fat was 53.6 ± 22.1 g in males and 43.0 ± 17.7 g in females as shown in Table 18. These contributed to a mean percentage of energy derived from fat of 30.4 ± 5.9% in males and 30.6 ± 5.8% in females (Figure 20). The fat intake ranged from 44.2 ± 17.0 g to 56.3 ± 23.1 g in males and, from 25.7 ± 11.9 g to 59.8 ±14.0 g in females.
Table 18 – Fat Intake Males Females
Age / Fat / g Age / Fat / g n n years old median ±SD years old median ±SD 5-6 40 48.6 14.5 5-6 43 44.4 15 7-9 85 51.1 18.2 7-9 89 47.9 19.2 10-12 72 51.3 22.1 10-12 66 45.2 18.2 13-15 66 47.4 20.1 13-15 53 59.8 14 16-18 62 54.8 22.1 16-18 65 52.5 20.6 19-59 619 56.3 23.1 19-59 745 42.3 17.2 60+ 54 44.2 17 60+ 59 25.7 11.9 Total 998 53.6 22.1 Total 1120 43 17.7
Figure 20: Mean Percentage of Energy from Fat Intake
Female Male
t F a
32.9 32.0 32.5 From 30.4 32.2 30.4 30.6 26.6 rg y n e E
%
32.4 31.5 30.2 30.9 30.5 30.4
ea n 29.0 28.4 M
5-6 7-9 10-12 13-15 16-18 19-59 60+ Total Age / Years Old
Figure 20 indicates that across the different age-groups, the percentage of energy derived from fats were between 28.4% to 32.4% in males and 26.6% to 32.9% infemales.
69 Although the WHO/FAO recommends a maximum of 30 to 35% of energy from fats for most individuals 19, 20 , for the purpose of this survey we have been using the Malaysian RNI recommendation of energy from fat intake which ranges from 20 to 30% 18. Nevertheless, when percentage energy from fat was further analysed, it was revealed that 53.3% of males and 54.6% of females derived their energy by more than 30% from fat, as shown by Figure 21.
Figure 21 : Percentage Consuming >30% Energy from Fat Intake
67.5 72.1 67.7 64.0 64.2 62.9 60.0 54.6 s t 51.4 51.5 53.6 52.9 53.3 39.4 cipa n i 37
ar t 28.8 P
%
5-6 7-9 10-12 13-15 16-18 19-59 60+ Total Age / Years Old Male Female
The source of energy derived from saturated fat ranged from 9.5% to 10.8% in males and 10.4% to 11.4% in females (Figure 22). The overall mean contribution was 10.5 ± 2.6% in males and 10.8 ± 2.7% in females. These figures are slightly higher than the WHO recommendation that saturated fats should contribute to less than 10% from total energy intake 19, 20.
Figure 22: Mean Percentage of Energy from Saturated Fat Intake
Female Male d rom c i f
A
11.4 11.2 10.8 10.8 rg y 10.4 11.2 10.5 Fa t 10.7 n e ed E
a t %
ea n 10.8 10.8 9.9 10.1 10.7 10.1 10.5 Satu r 9.5 M
5-6 7-9 10-12 13-15 16-18 19-59 60+ Total Age / Years Old
70 Consumption of more than 10% energy in their diet from saturated fat were reported in 55.4% of males and 58.5% of females (Figure 23). The percentage intake of saturated fat in different age- groups showed a range of 32.8% to 70% amongst males and 37.9% to 65.2% amongst females that consumed more than 10% energy from saturated fats. The results also indicated a high intake of saturated fat in young children, particularly males aged 5 to 6 years old (70%) and females aged 7 to 9 years old (65.2%).
Figure 23 : Percentage Consuming >10% Energy from Saturated Fat Intake
70.0 65.2 65.1 64.2 62.1 64.0 60.0 58.5 57.7 57.4 55.4 s
t 52.3 49.2 45.8 cipa n
i 37.9 32.8 ar t P
%
5-6 7-9 10-12 13-15 16-18 19-59 60+ Total Male Female Age / Years Old
The major source of fat in the diet came from from meat, providing 15.5% of males and 14.1% of females (Figure 24). Noodles and noodle dishes provided fat for 10.8% of males and 8.7% of females. Other food sources such as meat dishes, fish, battered or fried snacks, beverages and eggs and egg dishes contributed between over 5% to less than 10% of fat while 3% to 5% fat was derived from fast foods.
Figure 24 : Proportion of Total Fat Intake Obtained From Food Sources
3.8 Fast Food 5 7.5 Beverages 7.4 Salty Snacks 4.4 3.2 Battered / Fried Snacks 8.2 5.6 8.7 Female Noodle and Noodle Dishes 10.8 5.5 Male Egg and Egg Dishes 5.8 Fish 9.4 7.7 7.3 Meat Dishes 8.6 14.1 Meat 15.5 Food Sources Percentage (%)
71 Beverages were a major source of saturated fat in the diet (Figure 25) providing for 14.9% of males and 14.1% of females followed by meat with 13.8% of males and 12.2% of females. The rest of the food sources all contributed to less than 10% of saturated fat.
Figure 25 : Proportion of Total Saturated Fat Intake Obtained from Food Sources
3.8 Fast Food 4.6 14.1 Beverages 14.9 5.1 Salty Snacks 3.7 Battered / Fried Snacks 8.5 5.8 3.4 Noodle and Noodle Dishes 4.3 Female Dairy 6.8 5.6 Male 4.4 Egg and Egg Dishes 4.9 Fish 5.9 5.2 6.5 Meat Dishes 7.8 12.2 Meat 13.8 Food Sources Percentage (%)
8.8.1.5 Percentage Energy Contribution of Macronutrients to the Total Energy Intake Figure 26 shows the percentage energy contribution of macronutrients to the total energy amongst 18 years old and below. The figure indicates that the percentage of energy contribution from carbohydrates at 55% is below the recommended percentage energy. For protein, male across the groups shows higher intake in comparison to female. Only females aged 10 to 15 years old had intake above 15% of energy from protein. Fat intake was above 30% of the percentage of energy intake except for males aged 13 to 15 years old.
Figure 26 : Percentage Energy Contribution of Macronutrients to Total Energy Intake Amongst 18 years and Below
32.4 32.9 31.5 32.0 30.2 30.4 29.0 32.2 30.9 32.5 30.0
16.5 14.0 16.3 13.9 16.6 16.3 16.5 16.3 16.4 14.6 15.0
53.2 53.1 53.8 54.1 53.7 53.3 54.9 51.5 53.8 52.9 55.0
Male Female Male Female Male Female Male Female Male Female
5 to 6 7 to 9 10 to 12 13 to 15 16 to 18 Recommended
Age/Years Fat Protein CHO
72 Amongst adults, the percentage energy contribution of macronutrients to the total energy intake are presented in Figure 27. The energy contribution from carbohydrates show the percentage carbohydrates intake across the group was lower than 55%, with the exception of females aged 60 years and above (56.8%). Protein intake across the age groups show the protein contribution to the total energy was above 15%. Meanwhile, fat intake is shown to be slightly higher amongst adults aged 19-59 years, and lower amongst adults age 60 years and above.
Figure 27 : Percentage Energy Contribution of Macronutrients to Total Energy Intake Amongst Adults
26.6 30.5 30.4 28.4 30.0
19.5 17.3 17.4 19.9 15.0
52.2 52.9 53.9 56.8 55.0
Male Female Male Female
19-59 years 60 year and above Recommended
Fat Protein CHO
8.8.1.6 Fibre Intake
Table 19 – Fibre Intake
Age / years Fibre / g % Met Fibre RNI % Met 70% N old Median ±SD (>20g) Fibre RNI Males 5-6 39 8.8 3.1 0 5.1 7-9 86 8.5 3.0 0 7.0 10-12 71 9.8 4.0 2.8 14.1 13-15 67 9.4 4.6 6.0 26.9 16-18 61 10.0 4.4 3.3 29.5 19-59 620 12.8 5.4 10.3 41.1 60+ 54 13.3 5.0 11.1 46.3 Total 998 11.4 5.2 7.8 33.5 Females 5-6 44 7.9 3.5 0 6.8 7-9 88 8.1 3.7 1.1 9.1 10-12 66 9.0 3.9 1.5 15.2 13-15 54 9.2 4.2 3.7 14.8 16-18 65 9.9 3.8 3.1 15.4 19-59 744 10.5 4.3 3.9 24.7 60+ 59 10.0 5.1 5.1 25.4 Total 1120 10.1 4.3 3.4 21.3 73 Overall the median daily intake of dietary fibre was very low. The reported median daily intake of fibre in males was 11.4 ± 5.2 g with only 33.5% meeting the 70% of RNI for fibre (Table 19). Amongst 5 to 9 years old, less than 10% met 70% RNI 18. From age 10 years old and above, the range of median intakes were from 9.4 ± 4.6 g to 13.3 ± 5.0 g.
Even less consumption is noted amongst females where the median intake is 10.1 ± 4.3 g fibre per day, ranging from 7.9 ± 3.5 g to 10.5 ± 4.3 g. Only 3.4% met the RNI of above 20 g fibre per day while 21.3% met the 70% RNI. Within the different female age groups, not more than 5.1% of the respondents consumed over 20 g of fibre per day. Overall, the fibre intake is lower in females than males.
The main sources of fibre are noodle and noodles dishes with 14.3% of males and 10.9% of females (Figure 28). This is followed by fruits and vegetables. Rice, beverages and bread and crackers each provided less than 10% of fibre.
Figure 28 : Percentage Contribution Of Fibre Intake From Food Sources
8.4 Beverages 9.4
12 Vegetable 10.1
12.9 Fruit 9.7 Female 8 Male Bread and Crackers 8.5
8.5 Rice 9.7
Noodle and Noodle 10.9 Dishes 14.3 Food Sources Percentage (%)
74 8.8.1.7 Vitamin A Intake
Table 20 – Vitamin A Intake
Age / years old n Vitamin A (RE) / μg RNI (RE) Met Met 70% median ±SD μg Vitamin A RNI Vitamin A RNI Males % % 5-6 40 288.6 103.8 450 10.0 37.5 7-9 86 302.2 105.6 500 8.1 40.7 10 -12 71 315.6 109.8 600 1.4 14.1 13 -15 66 304.1 127.4 600 4.5 19.7 16 -18 60 346.5 172.0 600 5.0 25.0 19 -59 620 392.9 191.6 600 13.7 42.3 60+ 54 441.3 196.1 600 20.4 57.4 Total 997 362.8 179.7 - 11.4 38.2 Females 5-6 44 269.0 106.8 450 6.8 29.5 7-9 88 282.3 95.7 500 3.4 15.9 10 -12 65 277.9 118.1 600 1.5 16.9 13 -15 53 300.8 86.1 600 1.9 3.8 16 -18 67 320.0 108.0 600 0 19.4 19 -59 747 340.9 149.4 500 16.6 47.4 60 -65 26 348.5 199.6 500 30.8 50.0 65+ 33 336.1 182.3 600 12.1 30.3 Total 1123 321.8 144.1 - 12.8 38.3
The median intake of Vitamin A was 362.8 ± 179.7 RE/μg per day in males (Table 20). Only 11.4% of respondents met 100% RNI while 38.2% met 70% Vitamin A RNI. The proportions of males meeting 100% RNI ranged from 1.4% to 20.4% while the proportions meeting 70% RNI range from 14.1 to 57.4%. For females, the median daily intake was 321.8 ± 144.1 RE/μg (Table 20). In the different age-groups amongst the females, those meeting 100% RNI range from 0% to 30.8% while those meeting 70% RNI ranged from 3.8% to 50%.
Vegetable was the main source of vitamin A for both genders in this survey (Figure 29). The other food sources contributed to about 10% or less in both males and females.
Figure 29 : Percentage Contribution Of Vitamin A From Food Sources
7.8 Beverages 9.1 5.6 Female Dairy 5.1 Male 8.6 Soups 6.6 22.5 Vegetables 18.1 8.2 Fruit 7 8.9 Egg and Egg Dishes 10.4 7.6 Meat 7.7 Food Sources Percentage (%) 75 8.8.1.8 Calcium Intake As shown in Table 21, the median daily intake of calcium was 391.1 ± 218.8 mg in males and 337.9 ± 119.1 mg in females. Very few males met 100% RNI (6.2%) and only 22.9% met 70% RNI for calcium. Even fewer females achieved 100% RNI at 4.4% and, 15.8% met 70% RNI. At the most, only 25.6% of males and 16.3% of females from 5 to 6 years old met 100% RNI. Those meeting 70% RNI for calcium were highest amongst the 5 to 6 years old with 41% of males and 32.6% of females. Hence overall calcium intake amongst the 5 to 75 year old was very low particularly amongst the teenagers and older age-groups.
Table 21 – Calcium Intake
Age / years n Calcium / mg RNI / mg Met calcium Met 70% of old RNI calcium RNI
Males Median ±SD % % 5-6 39 365.4 251.1 600 25.6 41.0 7-9 87 387.1 207.2 700 4.6 31.0 10-12 72 363.9 215.6 1000 0 11.1 13-15 68 333.9 208.8 1000 1.5 5.9 16-18 60 301.4 225.1 1000 1.7 13.3 19-59 619 407.5 214.8 800 6.9 25.5 60-65 29 463.7 263.4 800 6.9 24.1 65+ 25 340.5 219.7 1000 4.0 4.0 Total 999 391.1 218.8 - 6.2 22.9 Females 5-6 43 302.1 231.6 600 16.3 32.6 7-9 89 289.6 247.4 700 9.0 30.3 10-12 64 341.6 202.0 1000 1.6 7.8 13-15 54 312.0 219.6 1000 0 13.0 16-18 67 292.8 189.4 1000 0 6.0 19-29 241 366.9 184.9 800 3.7 16.6 30-50 444 340.8 188.8 800 4.7 16.2 51-59 60 330.8 184.7 1000 1.7 6.7 60+ 59 312.6 226.9 1000 3.4 6.8 Total 1121 337.9 119.1 - 4.4 15.8 Daily contribution of calcium from beverages were 32.2% of males and 30.8% of females (Figure 30). Dairy sources contributed to 12.6% of males and 14.6% of females for calcium while the other food sources contributed to below 10% calcium.
Figure 30 : Percentage Contribution Of Calcium Intake from Food Sources
Toddler Formulae 1.2 1.1 Female Male 8.0 Fish 6.7 Legumes and Legume 6.1 Products 6.1 14.6 Dairy 12.6 30.8 Beverages 32.2 Percentage (%) Food Sources 76 8.8.1.9 Iron Intake The daily median intake of iron in males was 8.2 ± 2.8 mg and females was 7.0 ± 2.3 mg. In terms of meeting the RNI, 43% met 100% of iron RNI while only 78.2% met 70% of iron RNI. Amongst females, 10.6% met 100% of iron RNI and only 18.3% met 70% RNI for iron (Table 22). Within the different age–groups, 31.1% to 100% males met 70% RNI. In females, none of the 12 to 50 years old met 70% RNI whereas all of the 5 to 6 years old and over 50% of the other age-groups met 70% RNI. Similar to calcium, beverages contributed the most to iron in the diet of males and females. Vegetable, rice and meat contributed to about 10% or less iron while contribution of iron from formula milk in both genders was very minimal (Figure 31).
Table 22 – Iron Intake
Age / years old n Iron / µg RNI Met iron Met 70% of iron / mg RNI RNI median ±SD % % Males 5-6 40 7.2 2.6 4 92.5 100 7-9 85 6.9 2.1 6 74.1 96.5 10-12 72 7.5 2.1 10 11.1 58.3 13-14 55 7.6 3.0 10 21.8 72.7 15-18 74 7.0 2.2 12 5.4 31.1 19-59 621 8.7 2.8 9 45.2 82.3 60+ 54 8.7 4.2 9 46.3 83.3 Total 1001 8.2 2.8 - 43.0 78.2 Females 5-6 44 6.4 2.0 4 90.9 100 7-9 88 6.3 2.7 6 55.7 89.8 10-11 48 7.5 2.4 9 27.1 70.8 12-14 55 6.5 1.8 22 0 0 15-18 82 6.7 2.2 21 0 0 19-29 240 7.4 2.2 20 0 0 30-50 441 7.2 2.2 20 0 0.7 51-59 61 6.5 2.4 8 32.8 72.1 60+ 59 6.3 2.2 8 16.9 59.3 Total 1118 7.0 2.3 - 10.6 18.3
Figure 31 : Percentage Contribution Of Iron Intake From Food Sources
Toddler 0.9 Formulae 0.6
Beverages 16.3 15.1
Vegetables 10.9 Female 9.5 Male
Meat 7.8 8.7
Rice 8.3 9.2
Food Sources Percentage (%) 77 8.8.1.10 Zinc Intake The median daily intake of zinc were 6.5 ±0.9 mg in males and 5.1 ± 0.5 mg, in females. There were more females than males that met 100% zinc RNI and, 70% RNI for zinc (Table 23). In the different age-groups, all males aged 5 to 9 years old and 19 and above met 70% RNI while only between 11.1% to 23% of males aged 10 to 18 years old met 70% RNI. In females, almost all respondents in age-groups 5 to 9 and 19 years old and above met 70% RNI whereas less than 22.7% of the 10 to 18 years old met 70% RNI. Meat and rice were the two major sources of zinc in the diet providing between 17.2% to 19.1%. The other food sources such as meat dishes, fish, beverages and fast food contributed to about 10% or less (Figure 32).
Table 23– Zinc Intake Age / years n Zinc / mg RNI / Met zinc RNI Met 70% of old mg zinc RNI median ±SD % % Males 5-6 40 5.2 0.3 5.1 77.5 100 7-9 85 5.5 0.3 5.8 21.2 100 10-12 72 5.6 0.4 9.0 0 11.1 13-15 66 5.7 0.4 9.0 0 13.6 16-18 61 5.9 0.4 9.0 0 23.0 19-59 619 6.9 0.6 6.7 61.1 100 60-65 29 8.1 0.6 6.7 100 100 65+ 25 7.8 1.0 6.2 100 100 Total 997 6.5 0.9 - 48.2 83.1 Females 5-6 44 4.6 0.3 5.1 9.1 100 7-9 88 4.6 0.3 5.8 0 98.9 10-12 65 4.8 0.4 7.5 0 20.0 13-15 54 4.9 0.4 7.5 0 20.4 16-18 66 4.9 0.4 7.5 0 22.7 19-59 744 5.3 0.4 4.9 85.5 100 60-65 26 5.6 0.4 4.9 92.3 100 65+ 33 5.7 1.1 4.3 100 100 Total 1120 5.1 0.5 62.2 86.9
Figure 32 : Percentage Contribution Of Zinc Intake From Food Sources
3.3 Fast Food 4.0 Female Male Beverages 7.8 7.3 17.2 Rice 18 Fish 10.3 7.6 Meat 7.8 Dishes 9.1 17.4 Meat 19.1 Food Sources Percentage (%) 78 8.8.2 Short Food Frequency Questionnaire
8.8.2.1 Fruit Intake The median weekly fruit intake according to different age-groups and gender are shown in Figure 33. Overall, males consumed only 2 servings per week while females consumed 3 servings per week. In general higher fruit intake was noted amongst females than males in most age-groups. The lowest fruit intake of 2 servings per week was noted amongst the teenagers and adults while the highest fruit intake of 6 servings per week was observed amongst females 60 years old and above.
The results showed that fruit intake across all age-groups fall far below the recommended servings of 2 to 3 fruits per day 21, 22 or 14 to 21 servings per week.
Figure 33 : Fruit Intake
6
ek 4 e w /
a n 3 3 3 3 3 i e d
M 2 2 2 2 2
5 to 9 10 to 14 15 to 18 19 to 59 60+ Total
Age groups Males Females
8.8.2.2 Vegetable Intake The median weekly intake of vegetable according to different age-groups and gender are shown in Figure 34. In this survey, males were consuming 7 servings of vegetable per week while females were consuming 8 servings of vegetable per week. The median servings of vegetables per week were generally comparable between males and females. This is in exception for three age groups which were the 5 to 9 years, 19 to 59 years and above 60 years of age, where males had less servings of vegetables per week than females.
The difference in the median serving of vegetable per week between genders was particularly apparent in the 19 to 59 age group where males had 8 servings of vegetable whilst females had 12 servings of vegetable. The overall vegetable consumption was apparently higher amongst females aged 60 years and above at 14 servings per week. Male respondents aged from 5 to 60 years old were observed to consume less than the recommended servings of 2 to 3 vegetable per day 21, 22 or 14 to 21 servings per week.
79 Figure 34 : Vegetable Intake
14
12 12 ek e w
/ 8 8
a n 7 i 6 6 e d M 4 4 3 2
5 to 9 10 to 14 15 to 18 19 to 59 60+ Total
Age groups Males Females
8.8.2.3 Percentage of Respondents Eating 5 Servings of Fruit and/or Vegetables This survey showed that only 8.2% of the respondents had 5 or more servings of fruit and/or vegetables daily as shown in Figure 35. In addition to this, 91.8% of the respondents were not eating the recommended 5 servings of fruit and/or vegetables daily. Amongst the respondents, there were more females aged 60 years and above who had 5 or more servings of fruit and vegetables than others in the other age groups.
Figure 35 : Percentage of Respondents Eating 5 Servings of Fruit and/or Vegetables Daily
41.4
Male Female
13.2 9.7 9.5 8.9 7.3 8.2
2.9 2.7 2.3 1.6 0.7 0
5 to 9 10 to 14 15 to 18 19 to 59 60 + Total Overall Age Groups (Years old)
80 8.8.2.4 Meals Not Prepared at Home The survey result for meals not prepared at home are represented in Figure 36. The highest percentage of respondents that ate meals that were not prepared at home at least twice a week were aged 19-59 years old group with 64.7%. The lowest frequency of having meals not prepared at home was the highest amongst respondents aged 60 years and above with 64.0%.
Figure 36 : Percentage of Respondents Having Meals Not Prepared At Home
64
46.2 46.6 46 46.7 45.3 43.9 42.2 41.8 39.2 35.2 26.1
18 15.5 9.8 11.6 11.8 9.9
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age Groups (Years old)
Never or once a week or less 2-5 times a week 6 times a week or more
8.8.2.5 Breakfast Daily consumption of breakfast is presented in Figure 37. Breakfast was not daily consumed by male and female respondents across the age groups with the lowest percentage of having daily breakfast amongst the 15 to 18 years old group. It was also noted that more males aged 60 years and above (94.3%) ate breakfast daily compared to others males and females in the other age groups. Overall, there were more females (67.2%) than males (61.9%) that ate breakfast daily.
Figure 37 : Percentage of Respondents Having Breakfast Daily
94.3 Males Females 81.0 71.0 ) 67.2 67.2 68.8 67.2
% 61.9 61.9 ( 59.7 e a g t 41.3 43.0 erce n P
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age Groups (years old)
81 8.8.2.6 Types of Milk The intake of the different types of milk in all respondents is shown in Figure 38. Sweetened condensed milk was consumed by over one-third of the male respondents. The highest proportion of reported consumption of condensed milk was among those males aged 60 years and older at 41.5%.
The consumption patterns of males showed that 12.9% consumed low fat milk, 12.7% drank full cream milk, 8% consumed other milk and 2.4% used skimmed milk.
Figure 38 : Percentage Milk Consumption Amongst Respondents by Age-Groups
20.3 20.3 20 21.3 22.7 24.3 22.6 27 24.3 30.2 30.2 32.8 3.1 4.3 3.9 2.3 6.7 8.2 11.3 7.1 8 8.1 10 3.4 33.6 33.3 32.4 39.8 34.7 29 28.7 24.1 24.4 41.5 37.1 1.4 37.2 11.7 1.3 4.5 3.4 3.4 8.7 1.6 15.2 13.3 15.1 15.6 2.4 20.8 2.8 23.5 7.5 32.8 12.9 31.9 31.3 28.6 12.6 22.7 22.1 11.3 18 15.4 10.8 12.7 7.3 5.7 3.4 M F M F M F M F M F M F
5 to 9 10 to 14 15 to 18 19 to 59 60+ Total
Age Groups/Years old Do not Drink Other Sweet Condensed Skimmed Milk Low Fat Full Cream
The chart also showed that more males (27%) than females (24.3%) did not drink milk. Amongst the males, 30.2% of them aged 19-59 years old were not consuming milk.
The types of milk intake was almost similar amongst females (Figure 38) with 29% using sweetened condensed milk. Amongst the females, 20.8% used low fat milk, 15.4% consumed full cream milk, 7.1% used other milk and 3.4% drank skimmed milk. The highest consumption of sweetened condensed milk were in the youngest age group (33.3%).
The results also showed that 24.3% of the females did not drink milk. The highest proportion of self-reported non-milk intake were in the oldest age-group of 60 years and above (32.8%) and, the least amongst the 10 to 14 years old groups (20%).
82 8.8.2.7 Sugar-Sweetened Beverages / Soft Drinks The percentage of respondents who consumed sugar-sweetened beverages daily is represented in Figure 39. It is shown that more respondents aged 5 to 9 years old consumed more sugar sweetened beverages daily than other age groups. Females aged 60 years and above had the lowest percentage of respondents who consumed sugar-sweetened beverages daily at 1.7%.
Figure 39 : Percentage Daily Consumption of Sugar-Sweetened Beverages
39.1 38.4 35.9 30.7 26.7 24.8 23.3 23.0 23.6 24.4
13.2
1.7
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Male Female Age groups (years old)
WHO FAO Global Strategy on Diet, Physical Activity and Health21 recommends the intake of free (added) sugars should remain below 10% of energy intake and the consumption of foods/drinks containing free sugars should be limited to a maximum of four times per day. This recommendation is also supported by CDC and World Cancer Research Fund where youths should limit the intake of sugar-sweetened beverages and to drink more water and low-fat or fat-free milk and limit amounts of 100% fruit juices 23,24,25.
8.8.2.8 Instant Drinks Figure 40 shows that the daily consumption of instant drink was the highest amongst the 19 to 59 years old group. The lowest daily consumption of instant drink was seen amongst those aged 5-9 years old group.
Figure 40 : Percentage Daily Consumption of Instant Drinks
29.4 Male Female 26.9 23 20.8 21.3 19.0 17.3
11.0 10.5 10.5 7.0 6.5
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age groups (years old) 83 8.8.2.9 Types of Cooking Oil Palm-based oil is the most used cooking oil, with 76.1% of males and 78.1% of females reporting using it. This is a remarkable difference in comparison to other cooking oils such as polyunsaturated oil with 17.3%. The least used cooking oil among respondents is reported to be monounsaturated oil.
Figure 41 : Percentage Of Cooking Oil Most Used By Respondents
Monounsaturated Polyunsaturated Palm-based
1.6 1.4 3.9 4.8 1.4 1.2 3.5 2.5 3.8 5.7 6.9 2.6 10.2 16.7 14.8 17.6 18.6 16.6 17.3 17.3 18.1 18.5 26.4 24.1
87.5 81.2 81.3 81.1 79.1 78.7 76.1 78.1 Percentage (%) Percentage 74.3 73.1 67.9 69
M F M F M F M F M F M F 5 to 9 10 to 14 15 to 18 19 to 59 60+ Total Age Group / Years
8.8.2.10 Coconut Milk The highest percentage of coconut milk consumption of at least twice a week was among the 10 to 14 years old group with 17.1% as shown in Figure 42. The lowest frequency of intake was the highest amongst respondents aged 5 to 9 years old with 91.7%.
Figure 42: Percentage of Weekly Usage/Consumption of Coconut Milk
91.7 87 88.3 82.8 85.9 86.5
16.7 12.4 13.3 12.8 7.9 10.8 0.4 0.4 0.6 0.8 0.9 0.7
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age groups (years old) Never or once a week or less 2-5 times a week 6 times a week or more
84 8.8.2.11 Malay “Kuih” The intake of Malay “Kuih” at least twice a week was highest in respondents between 15 to 18 years with 41.7% as shown in Figure 43. Meanwhile, the highest percentage of respondents who consumed Malay “kuih” the least frequent was amongst the 5 to 9 years old group with 62.0%.
Figure 43 : Percentage of Respondents Consuming Malay ‘Kuih’
62.0 60.5 58.4 59.4 61.3 59.9
39.8 35.9 36.5 35.7 34.6 34.2
4.9 3.4 3.0 1.9 4.5 4.3
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age groups (years old) Never or once a week or less 2-5 times a week 6 times a week or more
8.8.2.12 Fast Food Analysis of the frequency of fast food intake per week showed that 51.5% of respondents aged 15 to 18 years old consumed fast foods at least twice a week (Figure 44). The highest percentage of respondents who had the lowest frequency of fast food intake was amongst the 60 and above age group with 93.7%.
Figure 44 : Percentage of Respondents Consuming Fast Food
93.7
65.9 63 55.4 50.8 48.4 48.4 38.7 37.3 29.5 31.7
10.5 7.3 4.6 6.3 5.3 3.1 0 5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age groups (years old) Never or once a week or less 2-5 times a week 6 times a week or more
85 8.8.2.13 “Nasi Katok” Analysis of the weekly consumption of Nasi Katok is presented in Figure 45. The highest consumption of Nasi Katok at least twice a week was amongst the aged 10 to 14 years old with 34.7%. The highest percentage of respondents who had the lowest frequency of intake was amongst the 60 years and above with 91.9%.
Figure 45 : Percentage of Respondents Consuming ‘Nasi Katok’
91.9 72.2 72.7 71.3 65.2 70.3
32.6 25.2 23.6 26.3 25.7
2.6 2.1 3.7 3.3 7.2 3 0.9
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age groups (years old) Never or once a week or less 2-5 times a week 6 times a week or more
8.8.2.14 Chicken Tail, Wing and Skin Figure 46 shows that the highest percentage of respondents consuming chicken tails, wings and skin at least twice a week was amongst the 15 to 18 years old age group with 47.2%. Those in the age group 60 years and above had the highest percentage for eating less frequent of chicken tails, wings and skin per week with 89.2%.
Figure 46 : Percentage of Respondents Eating Chicken Tails, Wings Or Skin
89.2
69.6 67 59.8 58.8 52.8 42.9 34.6 33.5 26.3 28.5 10.8 5.6 7.7 4.3 4 0 4.4 5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age groups (years old) Never or once a week or less 2-5 times a week 6 times a week or more
86 8.8.2.15 Instant Noodles
8.8.2.15 Figure Instant Noodles47 shows that the highest percentage of respondents consuming instant Figure 47noodles shows that at the least highest twice percentage a weekof respondents was in consumingthe 5 to9yearsold age instant group noodles with at least65.4%. twice a week wasWhereas, in the 5 to 9respondents years old age groupaged with 60 65.4%. years Whereas, and respondentsabove had aged the 60 yearshighest percentagefor and above had the highestconsuming percentage less frequent for consuming of instant less frequent noodles of per instant week noodles with 85.6%. per week with 85.6%.
Figure 47 : Percentage of Respondents Consuming Instant Noodles
85.6
58.7 53 54 48.1 42.9 42.9 40.8 38 34.6 34.9 Percentage (%)
14.3 14.4 12.4 11.2 6.4 7.9 0
5 to 9 10 to 14 15 to 18 19 to 59 60+ Total Age groups (years old) Never or once a week or less 2-‐5 times a week 6 times a week or more
8.8.2.16 Crisps (“Keropok”) Analysis on the frequency of eating crisps per week is shown in Figure 48. The highest percentage of respondents eating crisps at least twice a week was amongst the age 5 to 9 years old with 62.8%. Whereas, respondents aged 60 years and above had the highest percentage of respondents consuming less frequent of crisps with 94.6%.
Figure 48 : Percentage of Respondents Eating Crisps (“Keropok”)
94.6
68.4 63.4 54.1 55.3 39.5 37.2 37.8 37.9 23.3 24.2 27.5 8.2 6.8 7.4 9.1 4.5 0.9
5 to 9 10 to 14 15 to 18 19 to 59 60+ All Age Groups (years old) Never or once a week or less 2-5 times a week 6 times a week or more
87 8.9 Use of Food Supplements
Table 24 - Types of Food Supplements Used by Respondents Supplements Type Male Female Total n % n % n % Vitamins and minerals 208 20.3 264 22.9 472 21.6 Herbal supplements 39 3.8 58 5.0 97 4.4 Weight loss supplements 18 1.8 19 1.6 37 1.7 Weight gain supplements 15 1.5 3 0.3 18 0.8
Vitamins and minerals were the most common food supplements used by the respondents with 21.6% as shown in Table 24. There was slightly more females (22.9%) than males (20.3%) consuming these supplements. This was followed by herbal supplements (4.4%), weight loss supplements (1.7%) while use of weight gain products were reported by even fewer (0.8%).
Blood Pressure and Biochemical Analyses 9 for Age 20-75 Years Sub-groups
A total of 1488 respondents who were 20 years and above had blood pressure measured and blood taken for biochemical analyses. The blood pressure data and biochemical results of the respondents are shown in Table 25. The mean age of the respondents was 38.3 ± 12.5 years old.
Table 25: Characteristics of Table 25: Characteristics of Respondents Aged ≥ 20 Years of Age VARIABLE N MEAN SD Age (years) 1488 38.3 12.5 Systolic blood pressure (mmHg) 1488 129 19 Diastolic blood pressure (mmHg) 1488 79 11 Fasting blood glucose (mmol/L) 1396 5.2 1.6 2 hour blood glucose (mmol/L) 1283 6.4 2.8 HbA1c (%) 1379 5.9 1.7 Total cholesterol (mmol/L) 1394 5.0 1.0 HDL cholesterol (mmol/L) 1393 1.2 0.3 LDL cholesterol (mmol/L) 1385 3.2 0.9 Triglyceride (mmol/L) 1395 1.4 0.8 Creatinine (µmol /L) 1394 70.5 17.0 Haemoglobin (g/dL) 1389 13.9 1.9 88 There were more female (54.3%) compared to male (45.7%) as shown in Table 26. The Malay (86.5%) were the majority amongst the different ethnic groups, followed by Chinese (7.5%) and Others (6.0%). The mean HbA1c in this study was 5.9 ±1.7 %.
Table 26: Proportion of Respondents Aged ≥ 20 Years by Gender and Ethnicity
Group N % Sex Mal e 680 45.7 Femal e 808 54.3 Ethnicit y Malay 1287 86.5 Chines e 112 7.5 Others 89 6.0
9.1 Blood Pressure A total of 503 out of the 1488 respondents are recorded to have hypertension with a prevalence of 33.8%. The prevalence of hypertension increased with age as shown in Figure 49.
Figure 49: Percentage of Respondents For Hypertension by Age Groups (n=1488)
84.7
68.9
43.3
25.7
11.5
20-29 30-39 40-49 50-59 60+
Age Groups (Years)
High blood pressure: systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or on medication (tablets / pills) for high blood pressure26.
89 The gender distribution of hypertension in which males (36.5%) had a higher prevalence of hypertension compared to females (31.6%) as shown in Figure 50.
Figure 50: Percentage of Respondents For Hypertension According to Gender (n=1488)
36.5
31.6
Male Female
High blood pressure: systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or on medication (tablets / pills) for high blood pressure26.
The Chinese ethnic group (34.8%) has the highest prevalence of hypertension, followed by Malay (34%) and Others (30%) as shown in Figure 51.
Figure 51: Percentage of Respondents With Hypertension According to Ethnicity (n=1488)
34.8 34
30.3
Malay Chinese Others
High blood pressure: systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg or on medication (tablets/pills) for high blood pressure26.
90 9.2 Diabetes A total of 1396 out of the 1488 respondents had their glucose tolerance status evaluated based on the pre-defined criteria as outlined in Appendix B. Figure 52 shows the overall glucose tolerance status by age groups.
Figure 52: Percentage of Respondents According to Glucose Tolerance Status by Age Groups (n=1396)
0.9 Overall 74.7 12 5.4 7 rs) 60+ 39.6 2.8 22.6 7.6 27.4 e a y (
s 50-59 51.4 4.2 14.1 11.3 19
40-49 68.2 18.4 7 5.7 rou p
G 0.7
30-39 80.1 10.3 4.8 4.6 g e
A 0.2 20-29 90.3 6 1.2 0.2 2.3
Normal IFG IGT Newly diagnosed DM Known DM
NGT = Normal glucose tolerance; IFG = Impaired Fasting Glucose (fasting blood glucose of 6.1 to 6.9 mmol/L); IGT = Impaired Glucose Tolerance (fasting blood glucose of ≤7 mmol/L and a 2 hour blood glucose of 7.9 to 11.0 mmol/L following a WHO 75gm Oral Glucose Tolerance Test); *Newly diagnosed diabetes based on fasting blood glucose ≥7.0 mmol/L and/or 2 hour blood glucose ≥ 11.1 mmol/L for those with no known diabetes following a WHO 75gm Oral Glucose Tolerance Test; Known DM= self-reported DM and on treatment with oral agents and/or insulin 27.
The overall prevalence of diabetes is 12.4%, of which 5.4% were first detected during this study. Prevalence of diabetes was seen to increase with age as shown in Figure 53. For those aged 20-49 years, the incidence of newly diagnosed diabetes detected using oral glucose tolerance test (OGTT) exceeded the prevalence of known diabetes.
Figure 53: Percentage of Respondents with Diabetes by Age Groups (n=1396)
Total Newly diagnosed DM Known DM 27.4
19
11.3 12.4 7 7.6 7 4.8 4.6 5.7 5.4 2.3 1.2
20-29 30-39 40-49 50-59 60+ Overall Age groups (years)
NGT = Normal glucose tolerance; IFG = Impaired Fasting Glucose (fasting blood glucose of 6.1 to 6.9 mmol/L); IGT = Impaired Glucose Tolerance (fasting blood glucose of ≤7 mmol/L and a 2 hour blood glucose of 7.9 to 11.0 mmol/L following a WHO 75gm Oral Glucose Tolerance Test); *Newly diagnosed diabetes based on fasting blood glucose ≥7.0 mmol/L and/or 2 hour blood glucose ≥ 11.1 mmol/L for those with no known diabetes following a WHO 75gm Oral Glucose Tolerance Test; Known DM= self-reported DM and on treatment with oral agents and/or insulin 27. 91 Females had a higher prevalence for diabetes and impaired glucose tolerance (IGT) compared to males (Figure 54).
Figure 54: Percentage of Respondents According to Glucose Tolerance Status by Gender (n=1396) Normal IFG IGT New diagnosed DM Known DM 78.3 71.8
14.5 9 1 5.2 6.5 0.9 5.5 7.3
Male Female
NGT = Normal glucose tolerance; IFG = Impaired Fasting Glucose (fasting blood glucose of 6.1 to 6.9 mmol/L); IGT = Impaired Glucose Tolerance (fasting blood glucose of ≤7 mmol/L and a 2 hour blood glucose of 7.9 to 11.0 mmol/L following a WHO 75gm Oral Glucose Tolerance Test); *Newly diagnosed diabetes based on fasting blood glucose ≥7.0 mmol/L and/or 2 hour blood glucose ≥ 11.1 mmol/L for those with no known diabetes following a WHO 75gm Oral Glucose Tolerance Test; Known DM= self-reported DM and on treatment with oral agents and/or insulin 27.
Figure 55 illustrates the glucose tolerance status amongst the various ethnic groups. The non-Malay, non-Chinese ethnic groups (Others) had the highest prevalence for diabetes at 16.5%, followed by Malay at 12.7% and Chinese at 5.6%. However, Malay (12.4%) had the highest prevalence for impaired glucose tolerance (IGT) and Chinese (1.9%) had the highest prevalence for impaired fasting glucose (IFG).
Figure 55: Percentage of Respondents According to Glucose Tolerance Status Amongst The Ethnic Groups (n=1396)
83.2
74.2 71.8
12.4 10.6 7.1 9.4 7.1 9.4 5.6 3.7 0.8 1.9 1.9 1.2
Malay Chinese Others Normal IFG IGT New Diagnosed DM Known DM
NGT = Normal glucose tolerance; IFG = Impaired Fasting Glucose (fasting blood glucose of 6.1 to 6.9 mmol/L); IGT = Impaired Glucose Tolerance (fasting blood glucose of ≤7 mmol/L and a 2 hour blood glucose of 7.9 to 11.0 mmol/L following a WHO 75gm Oral Glucose Tolerance Test); *Newly diagnosed diabetes based on fasting blood glucose ≥7.0 mmol/L and/or 2 hour blood glucose ≥ 11.1 mmol/L for those with no known diabetes following a WHO 75gm Oral Glucose Tolerance Test; Known DM= self-reported DM and on treatment with oral agents and/or insulin 27. 92 9.3 Lipids A total of 1395 out of the 1488 respondents had their fasting lipid levels measured. In this study, the prevalence of dyslipidaemia is 73.8% as shown in Figure 56. Dyslipidaemia increased with age and peaked in the 50-59 years age group.
Figure 56: Percentage of Respondents Within Age Group For Abnormal Lipid Levels
Overall 40.5 42.1 37.2 23.6 73.8
s) 60+ 38.7 34.9 33 31.1 84 ea r y ( 50 - 59 51.1 41.8 42.5 28.9 86.6 oups
g r 40 - 49 44.2 47.8 41.1 26.4 83.3 ge A 30 - 39 43.3 46.2 42.1 21.9 74.8
20 - 29 32.4 36 29 19.7 59.5
Total Cholesterol (n= 1394) Low HDL-C (n=1393) LDL-C (n=1385) Triglyceride (n=1395) Dyslipidaemia (n=1395)
Total cholesterol > 5.2 mmol/L; HDL cholesterol < 1.0 mmol/L for men and < 1.3 mmol/L for women; LDL cholesterol >2.6 mmol/L; Triglyceride > 1.7 mmol/L; Dyslipidaemia = abnormal HDL cholesterol, LDL cholesterol or triglyceride levels or on medication (tablets/pills) for high blood cholesterol.
As shown in Figure 57, there was not much difference in the prevalence of dyslipidaemia between genders. However, there was an observed increase in the proportion of female respondents who had elevated low-density lipoprotein (LDL) levels.
Figure 57: Percentage of Respondents For Abnormal Lipid Levels by Gender
72.7 74.6
52.2 41.8 39.3 39.5 35.5 29.9 32.7 16.1
Male Female Total cholesterol Low HDL-cholesterol LDL-cholesterol Triglyceride
Total cholesterol > 5.2 mmol/L; HDL cholesterol < 1.0 mmol/L for men and < 1.3 mmol/L for women; LDL cholesterol >2.6 mmol/L; Triglyceride > 1.7 mmol/L; Dyslipidaemia = abnormal HDL cholesterol, LDL cholesterol or triglyceride levels or on medication (tables/pills) for high blood cholesterol.
93 The abnormal lipid levels seen in the various ethnic groups is represented in Figure 58. The non-Malay, non-Chinese ethnic groups (Others) had the highest prevalence of dyslipidaemia (76.5%), followed by Malay (74.1%) and Chinese (68.2%). However, Malays (37.7%) had the highest prevalence for elevated low density lipoprotein (LDL) levels.
Figure 58: Percentage of Respondents For Abnormal Lipid Levels by Ethnicity
74.1 76.5 68.2
47.6 42.6 40.6 39.3 41.2 37.7 35.5 31.8 32.5 28.2 23.3 23.4
Malay Chinese Others
Total cholesterol Low HDL-cholesterol LDL-cholesterol Triglyceride Dyslipidaemia
Total cholesterol > 5.2 mmol/L; HDL cholesterol < 1.0 mmol/L for men and < 1.3 mmol/L for women; LDL cholesterol > 2.6 mmol/L; Triglyceride > 1.7 mmol/L; Dyslipidaemia = abnormal HDL cholesterol, LDL cholesterol or triglyceride levels or on medication (tables/pills) for high blood cholesterol.
9.4 Creatinine A total of 1394 out of 1488 respondents had their blood creatinine measured. For the purpose of this survey, abnormal creatinine values are defined as abnormal low or abnormal high creatinine values. Abnormal creatinine values were recorded in 2.4% of the respondents. The prevalence of overall abnormal creatinine values increased with age from 30 years onwards as shown in Figure 59. It was observed that there was a slight increase in the prevalence of abnormal creatinine values in the 20-29 age group.
Figure 59: Percentage of Respondents With Abnormal Creatinine Values by Age Groups (n=1394) 7.6 6.7
5.6 4.9
2.3 2.4 1.7 1.7 1.3 1.2 1.2 1 0.5 0.5 0.3 0.7 0.7 0
20-29 30-39 40-49 50-59 60+ Overall Age groups (years) Overall abnormal Low abnormal High Abnormal
Abnormal creatinine values: 60umol/l < Creatinine > 110umol/l for men and 45umol/l < Creatinine > 90umol/l for women. 94 Males (2.7%) had a higher prevalence compared to females (0.8%) for abnormal creatinine values as shown in Figure 60.
Figure 60: Percentage of Respondents With Abnormal Creatinine Values According to Gender (n=1394)
4
2.7
1.3 1.1 0.8 0.3
Male Female
All abnormal Low abnormal High abnormal
Abnormal creatinine values: 60umol/l < Creatinine > 110umol/l for men and 45umol/l < Creatinine > 90umol/l for women.
The abnormal creatinine values according to the various ethnic groups is shown in Figure 61. Malay had the highest prevalence for any abnormal creatinine values (2.5%) and high abnormal creatinine values (1.8%). Meanwhile, Chinese had the highest prevalence for low abnormal creatinine values at 1.9%.
Figure 61: Percentage of Respondents With Abnormal Creatinine Values According to Ethnicity (n=1394)
2.5
1.8 1.9 1.9
1.2 1.2
0.7
0 0
Malay Chinese Others All abnormal Low abnormal High abnormal
Abnormal creatinine values: 60umol/l < Creatinine > 110umol/l for men and 45umol/l < Creatinine > 90umol/l for women.
95 9.5 Haemoglobin A total of 1389 out of the 1488 respondents had their haemoglobin measured and the anaemia status by age groups is illustrated in Figure 62. The majority of the respondents (85.7%) were non-anaemic across all age groups as shown in Figure 63.
Figure 62: Percentage of Respondents Within Subgroup For Anaemic Status by Age Groups (n=1389)
Overall 85.7 8.7 4.8 0.8
> 60 87.7 9.4 2.8 ps 50-59 84.2 11.5 3.6 0.7 gro u
40-49 81.5 10.1 6.7 1.7 g e A 30-39 85.8 8.2 5.5 0.5
20-29 88.4 7.2 3.7 0.7
Non-anaemic Mild Moderate Severe
Mild: haemoglobin 11.0-12.9 g/dL for men and 11.0-11.9 g/dL for women; Moderate: haemoglobin 8.0-10.9 g/dL for men and 7.0-9.9 g/dL for women; Severe: haemoglobin <8.0 g/dL for men and <7.0 g/dL for women 28.
Figure 63: Percentage of Respondents For Anaemia Status – Overall Figures (n=1389)
85.7
8.7 4.8 0.8
Percentage
No anaemia Mild anaemia Moderate anaemia Severe anaemia
Mild: haemoglobin 11.0-12.9 g/dL for men and 11.0-11.9 g/dL for women; Moderate: haemoglobin 8.0-10.9 g/dL for men and 7.0-9.9 g/dL for women; Severe: haemoglobin <8.0 g/dL for men and <7.0 g/dL for women 28.
96 Females were observed to have a higher incidence of anaemia in this survey as shown in Figure 64.
Figure 64: Percentage of Respondents For Anaemia According to Gender (n=1389)
95.4 77.6
12.8 8.2 3.8 0.8 0 1.5
Male Female
Non-anaemic Mild Moderate Severe
Mild: haemoglobin 11.0-12.9 g/dL for men and 11.0-11.9 g/dL for women; Moderate: haemoglobin 8.0-10.9 g/dL for men and 7.0-9.9 g/dL for women; Severe: haemoglobin <8.0 g/dL for men and <7.0 g/dL for women 28.
Amongst the various ethnic groups as shown in Figure 65, Malays (9.1%) and Others (9.5%) were observed to have the highest incidence of mild and moderate anaemia respectively.
Figure 65: Percentage of Respondents Within Subgroup For Anaemia Status According to Ethnicity (n=1389)
93.4
85.2 82.1
9.5 9.1 4.7 8.3 4.8 0.8 0.9 0.9 0
Malay Chinese Others
No anaemia Mild anaemia Moderate anaemia Severe anaemia
Mild: haemoglobin 11.0-12.9 g/dL for men and 11.0-11.9 g/dL for women; Moderate: haemoglobin 8.0-10.9 g/dL for men and 7.0-9.9 g/dL for women; Severe: haemoglobin <8.0 g/dL for men and <7.0 g/dL for women 28.
97 10 Conclusion
The 2nd NHANSS was a comprehensive national health survey conducted in Brunei Darussalam. This report provides detailed information and highlights on the health and nutritional status of the population. The survey was carried out on a nationally representative sample of the population aged 5 to 75 years old throughout the four districts from June 2010 to March 2011. A total of 2184 respondents comprising of 1027 males and 1157 females took part in interviews to gather basic socio-demographic information, past medical history such as hypertension, dyslipidaemia and diabetes, smoking status, physical activity levels and food intake history. Blood pressure and anthropometric measurements were also taken during the survey. In addition, a sub-study consisting of biochemical analyses was conducted in the 20-75 years age group.
Several key findings of this survey have been highlighted in the Executive Summary of this report. These findings provided baseline indications of the key risk factors for noncommunicable diseases amongst the population, including physical activities, smoking and dietary habits. It provides the basis to strengthen efforts to reduce related risk factors using effective population-based strategies.
More than one third (35.5%) of the population did not meet the national recommendation 29, 30 for moderate intensity physical activity of more than 150 minutes per week. The overall amount of time spent being physically active is much lower compared to the total sedentary time spent on resting, being inactive and watching television.
A high smoking prevalence of 35.5% was found amongst men with a median of ten cigarettes per day. Amongst the women, 4% were current smokers with a median of four cigarettes per day.
Low fruits and vegetables intake was reported amongst the respondents with only 8.2% who consumed the daily national recommendation of servings of fruits and/or vegetables 22.
Based on the 24-hour dietary recall, low calcium intake was reported in both males (391.1 mg) and females (337.9 mg). Overall, the daily median intake of iron in males was 8.2 mg per day and females was 7.0 mg per day which is below the Recommended Nutrient Intake (RNI)18. Of concern, none of the female respondents in the age group 12 to 29 years met the 70% of the RNI for iron.
Sweetened condensed milk was the most commonly consumed milk where it was taken by 37.1% of males and 29% of females. Across all age groups, 27% of males and 24.3% of females did not consume any type
98 of milk. Sugar sweetened beverages were consumed daily by 26.7% of males and 24.4% of females. The most commonly used cooking oil in the household was palm oil based where 76.1% of males and 78.1% of females reported its usage.
In the adults, 60.5% have BMI of more than 25kg/m2 of which 33.4% were seen to be overweight and 27.1% were obese. For respondents aged 5 to 18 years, 33.5% were overweight and 18.2% were obese. Conversely in the same age group, moderate stunting was seen in 15.6% and severe stunting in 2.3%.
Amongst the respondents aged 19-75 years, self-reporting of hypertension, diabetes and dyslipidaemia was found to be 19%, 17.2% and 37.1% respectively. In the sub-study analysis of 20-75 years, a total of 1488 respondents had their blood pressure measured and blood taken for biochemical analyses. Hypertension was seen in 33.8% of the respondents in which males (36.5%) had a higher prevalence than females (31.6%). The diabetes prevalence is 12.4% and a higher proportion of Malays had impaired glucose tolerance while the Chinese had the highest proportion for impaired fasting glucose. Dyslipidaemia was seen in 73.8% of all respondents.
In the sub-study analysis of 20-75 years, only 2.4% had abnormal creatinine levels. A total of 85.7% of respondents were non-anaemic across all age groups. Amongst those with anaemia, females had a higher prevalence with 22.5% compared with 4.6% seen in male respondents.
99 11 References
1. MOH (2011) Health Information Booklet 2011, Department of Policy and Planning, Ministry of Health, Brunei Darussalam 2. MOH (1997) Report 1st National Nutritional Status Survey. Ministry of Health, Brunei Darussalam 3. MOH (2013) The Report: 2nd National Health and Nutritional Status Survey (NHANSS). Phase 1: 0-5 years old. Ministry of Health, Brunei Darussalam 4. PMO (2010). Brunei Darussalam Statistical Yearbook 2010. Department of Statistics, Department of Economic Planning and Development, Prime Minister’s Office, Brunei Darussalam. http://www.depd. gov.bn/SI/BDSYB2010/BDSYB% 202010.pdf. (Accessed on 23 November 2013) 5. WHO STEPS Manual. http://www.who.int/chp/steps/manual/en/index.html (Accessed on 11 April 2013) 6. PMO (2010) Brunei Household Expenditure Survey 2010/11. Department of Economic Planning and Development, Prime Minister’s Office, Brunei Darussalam 7. WHO (2004) WHO’s Global Physical Activity Questionnaire (GPAQ). http://www.who.int/chp/steps/ resources/GPAQ_Analysis_Guide.pdf (Accessed on 11 April 2013) 8. SPSS IBM Statistics 15.0 9. FoodWorks® Professional 2009. Xyris Software, Australia 10. WHO (1995) Physical Status: the use and interpretation of anthropometry. Report of a WHO expert committee. Technical Report Series No. 854. Geneva: WHO 11. U.S. Department of Health and Human Services. Public Health Service, Centres for Disease Control and Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. http://www.cdc.gov/physicalactivity/downloads/PA_Intensity_ table_2_1.pdf (Accessed 11 April 2013) 12. Thomson F.E and Subar A.F (2012), ‘Dietary Assessment Methodology’, In Coulston, A., Boushey, C, and Ferruzzi, M (Ed). Nutrition in the Prevention and Treatment of Disease (3rd Edition). London: Elsevier Inc, pp 5-46 13. Department of Epidemiology of the German Institute of Human Nutrition Potsdam-Rehbrücke (DifE). The Multiple Source Method (MSM). https://msm.dife.de/ (Accessed 21 November 2013) 14. James WPT, Chen C, Inoue S. Appropriate Asian body mass indices? Obesity Review, 2002; 3:139 15. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet, 2004; 157-163 16. World Health Organisation Global Database on Child Growth and Malnutrition. http://www.who.int/ nutgrowthdb/about/introduction/en/index2.html. Accessed 22 November 2014 17. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization, 2000 18. MOH (2005) Recommended Nutrient Intakes (RNI) for Malaysia. A Report of the Technical Working Group on Nutritional Guidelines. Ministry of Health, Malaysia 100 19. WHO/FAO (1993) Fats and oils in human nutrition. Report of a Joint FAO/WHO Expert Consultation, Rome 20. FAO (2010). Fats and Fatty Acids In Human Nutrition. Report of an Expert Consultation. FAO Food and Nutrition Paper 91, FAO, Geneva 21. World Health Assembly 57.17. Global strategy on diet and physical activity. Geneva: World Health Organization; 2004 22. MOH (2000). Brunei Darussalam National Dietary Guideline. Ministry of Health, Brunei Darussalam 23. World Health Organisation. Oral Health. http://www.who.int/oral_health/action/risks/en/ (Accessed 6 November 2013) 24. Centers for Disease Control and Prevention. Reducing Access to Sugar-sweetened Beverages Among Youth. http://www.cdc.gov/features/healthybeverages/ (Accessed 6 November 2013) 25. World Cancer Research Fund. Energy-densed foods, sugary drinks and cancer prevention. http:// www.wcrf- uk.org/cancer_prevention/recommendations/energy_ density_and_cancer.php. Accessed 6 November 2013) 26. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): final report. Circulation. 2002, 106:3143-3421 27. World Health Organization: Definition, Diagnosis and Classification of Diabetes Mellitus andits Complications: Report of a WHO/IDF Consultation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Geneva, World Health Organization, 2006 28. World Health Organization: Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 29. WHO (2010) Global recommendations on physical activity for health. Geneva: World Health Organisation 30. MOH (2011) National Physical Activity Guidelines for Brunei Darussalam. Ministry of Health, Brunei Darussalam
101 12 Appendices
Questionnaire Booklet Brunei Darussalam 2nd National Health Appendix A and Nutritional Status Survey (NHANSS) Phase 2
2nd National Health and Nutritional Status Survey and Diabetes Appendix B Prevalence Sub-Study Training Manual
Appendix C General Physical Activities Defined by Level of Intensity
Self Reported Health Status (Medical Conditions) For Respondents Appendix D Aged 19 Years and Above (n=1524)
Median Serves / Week of Specific Foods and Frequency Among Appendix E Males and Females Respondents
102 Appendix A Questionnaire Booklet Brunei Darussalam 2nd NHANSS (Phase 2)
103 104 B No. 0001 SEMUA KETERANGAN ADALAH DIRAHSIAKAN
ALL INFORMATION IS KEPT STRICTLY CONFIDENTIAL
KAJISELIDIK STATUS KESIHATAN DAN PERMAKANAN KEBANGSAAN KEDUA, KEMENTERIAN KESIHATAN, NEGARA BRUNEI DARUSSALAM 2009-2011
THE SECOND NATIONAL HEALTH AND NUTRITIONAL STATUS SURVEY MINISTRY OF HEALTH, BRUNEI DARUSSALAM 2009-2011
BORANGTANYA FASA 2 / QUESTIONNAIRE PHASE 2 Untuk diisikan oleh Penemuduga / To be completed by the Interviewer
Dalam Bandar /Luar Bandar Daerah Urban / Rural District
Mukim Kampung / Kawasan / Locality
Kawasan Kajian No Pemilihan Segmen Enumeration Area Segment Selection No.
No. Tempat Kediaman No Isirumah House No. Household No.
No. Subjek Subject No.
Untuk Kegunaan Pejabat Sahaja / For Official Use Only Kod / Tandatangan/ Tarikh HH/BB/TTTT Time Code Signature Date DD/MM/YYYY Penemuduga / Interviewer Penyunting / Verifier Penyemak Kod / Code Examiner Pengisi data / Data entered by Data disemak oleh/ Entered data verified by
137
Kegunaan A. DEMOGRAFI/DEMOGRAPHY Resmi Official Use
Nama Ketua Isirumah Name of Head of Household
Semua Umur ≥ 20 Umur > 5-19.99 Umur 0-5 Ahli Isirumah All Age ≥ 20 Age > 5-19.99 Age 0-5 Jumlah Household Total Composition Lelaki / Male
Perempuan Female Ada anak umur 0-5 dalam isirumah terpilih dalam Kajian Fasa 1? Any child aged 0-5 in your household selected during Phase 1 Survey? 1. Ada / Yes 2. Tidak Ada / No
Alamat Address
Pos Kod / Post Code
Telefon / Rumah / House Telephone
Pejabat / Office
Bimbit / Mobile
1. Kaitan dengan Ketua Isirumah / Relationship to Head of HH 1. Ketua Isirumah / Head Household 2. Suami atau Isteri / Husband or Wife 3. Anak atau Menantu / Child or Child In-Law 4. Cucu / Grandchild 5. Ibu-Bapa atau Mentua / Parents or Parents In-Law 6. Nenek / Grandparent 7. Anak Angkat / Adopted Child 8. Lain-lain / Others Kegunaan A. DEMOGRAFI/DEMOGRAPHY Resmi Official Use
2. Nama Subjek / Subject Name ______
3. No KP / IC No
4. Warna KP / IC Colour 1. Kuning / Yellow 2. Ungu / Purple 3. ABDB atau Polis / RBAF or Police 4. Lain-lain / Others 999. Tidak Berkenaan / Not Applicable
5. Tarikh Lahir HH/BB/TTTT Date of Birth DD/MM/YYYY
6. Jantina / Gender
1. Lelaki / Male 2. Perempuan / Female
Subjek dibawah umur 12 tahun / Subject below 12 years old
7. Guna KP / IC of 1. Bapa / Father 2. Ibu / Mother 3. Lain-lain / Others 999. Tidak Berkenaan / Not Applicable Kegunaan A. DEMOGRAFI/DEMOGRAPHY Resmi Official Use
8. Taraf Penduduk / Residential Status
1. Rakyat Brunei / Brunei Citizen 2. Penduduk Tetap / Permanent Resident 3. Lain-lain / Others
9. Bangsa / Ethnicity
1. Melayu Brunei / Brunei Malay (Brunei, Tutong, Belait, Temburong) 2. Melayu Brunei Lainnya / Other Brunei Malay (Dusun, Bisaya, Murut, Kedayan) 3. Puak Asli Lain / Other Indigenous (Iban, Punan, Kelabit) 4. Cina / Chinese 5. Lain-lain / Others
10. Ugama / Religion: 1. Islam 2. Kristian / Christian 3. Buddha / Buddhist 4. Hindu 5. Lain-lain / Others
11. Taraf Perkahwinan / Marital Status:
1. Bujang / Single 2. Kahwin / Married 3. Cerai / Divorced 4. Duda atau Balu / Widowed Kegunaan B. STATUS SOSIO EKONOMI / SOCIO ECONOMIC STATUS Resmi Official Use
12. Status Tempat Kediaman / Housing Status:
1. Milik Sendiri / Own House 2. Disewa / Rented 3. Disediakan percuma oleh Majikan / Provided free by employer 4. Disediakan oleh majikan dengan sewa / Provided by employer with rent 5. Disediakan percuma oleh ibu bapa / Provided free by parents 6. Lain-lain / Others
13. Bekalan elektrik ke rumah / Electricity supply to the house 1. Ada / Yes 2. Tidak Ada / No
14. Bekalan Air Paip ke rumah / Piped water supply to the house 1. Ada / Yes 2. Tidak Ada / No
15. Pekerjaan / Employment
1. Tidak Bekerja / Unemployed 2. Bekerja dengan Kerajaan / Employed by Government 3. Bekerja dengan Sektor Swasta / Employed by Private Sector 4. Penuntut / Student 5. Suri Rumah / Housewife 6. Bekerja Sendiri / Self-employed 999. Tidak Berkenaan / Not Applicable
16. Tahap Pendidikan Tertinggi / Highest Education level
1. Tiada Pendidikan Formal / No Formal Education 2. Sekolah Rendah (Dr 1-6) / Primary (Primary 1-6) 3. Sekolah Menengah (Tkt 1-5) / Secondary (Form 1-5) 4. Teknikal atau Vokasional / Technical or Vocational / OND 5. Peringkat ‘A’ / ‘A’ Level / HND 6. Sarjana Muda - PhD / Degree - PhD 666. Tidak Tahu / Don’t Know 999. Tidak Berkenaan / Not Applicable Kegunaan B. STATUS SOSIO EKONOMI / SOCIO ECONOMIC STATUS Resmi Official Use
17. Jumlah Pendapatan subjek Sebulan BND / Subject’s income per Month in BND:
1. Kurang / Less than $600 2. $600-$999 3. $1000-$1999 4. $2000-$2999 5. $3000-$3999 6. $4000 ke atas / $4000 and above 666. Tidak Tahu / Don’t Know 999. Tidak berkenaan / Not Applicable
18. Dalam masa 12 bulan lalu adakah pernah awda mengalami tidak cukup makanan dan tidak mampu membeli makanan?
During the past 12 months, were there any times you ran out of food and could not afford to buy more food?
1. Ada / Yes 2. Tidak Ada / No 666. Tidak Tahu / Don’t Know 888. Tiada Jawapan / No Answer / Refuse 999. Tidak berkenaan / Not Applicable Kegunaan B. STATUS SOSIO EKONOMI / SOCIO ECONOMIC STATUS Resmi Official Use
Subjek Dibawah Umur 18 Tahun / Subject below 18 years old:
19. Pekerjaan Bapa / Father’s Employment:
1. Tidak Bekerja / Unemployed 2. Bekerja dengan Kerajaan / Employed by Government 3. Bekerja dengan Sektor Swasta / Employed by Private Sector 4. Penuntut / Student 5. Bekerja Sendiri / Self-employed 666. Tidak Tahu / Don’t Know 999. Tidak Berkenaan / Not Applicable
20. Tahap Pendidikan Tertinggi bapa / Father’s Highest Education level:
1. Tiada Pendidikan Formal / No Formal Education 2. Sekolah Rendah (Dr 1-6) / Primary (Primary 1-6) 3. Sekolah Menengah (Tkt 1-5) / Secondary (Form 1-5) 4. Teknikal atau Vokasional / Technical or Vocational / OND 5. Peringkat ‘A’ / ‘A’ Level / HND 6. Sarjana Muda - PhD / Degree - PhD 666. Tidak Tahu / Don’t Know 999. Tidak Berkenaan / Not Applicable
21. Pekerjaan Ibu / Mother’s Employment:
1. Tidak Bekerja / Unemployed 2. Bekerja dengan Kerajaan / Employed by Government 3. Bekerja dengan Sektor Swasta / Employed by Private Sector 4. Penuntut / Student 5. Suri Rumah / Housewife 6. Bekerja Sendiri / Self-employed 666. Tidak Tahu / Don’t Know 999. Tidak Berkenaan / Not Applicable Kegunaan B. STATUS SOSIO EKONOMI / SOCIO ECONOMIC STATUS Resmi Official Use
22. Tahap Pendidikan Tertinggi Ibu / Mother’s Highest Education level:
1. Tiada Pendidikan Formal / No Formal Education 2. Sekolah Rendah (Dr 1-6) / Primary (Primary 1-6) 3. Sekolah Menengah (Tkt 1-5) / Secondary (Form 1-5) 4. Teknikal atau Vokasional / Technical or Vocational / OND 5. Peringkat ‘A’ / ‘A’ Level / HND 6. Sarjana Muda - PhD / Degree - PhD 666. Tidak Tahu / Don’t Know 999.Tidak Berkenaan / Not Applicable
23. Jumlah Pendapatan Ibu bapa Sebulan BND / Total Parental Income per Month in BND:
1. Kurang / Less than $600 2. $600-$999 3. $1000-$1999 4. $2000-$2999 5. $3000-$3999 6. $4000 ke atas / $4000 and above 666. Tidak Tahu / Don’t Know 999. Tidak Berkenaan / Not Applicable Kegunaan B. STATUS SOSIO EKONOMI / SOCIO ECONOMIC STATUS Resmi Official Use
24. Adakah awda pada masa ini menghisap apa jua jenis produk tembakau seperti rokok, tembakau, kertas rokok, cerut atau paip?
Do you currently smoke any tobacco products such as cigarettes, cigars or pipes?
1. Ya / Yes 2. Tidak / No (Pergi ke soalan Q29 / Go to Q29)
25. Adakah awda menghisap apa jua jenis produk tembakau setiap hari?
Do you currently smoke tobacco p
1. Ya / Yes 2. Tidak / No (Pergi ke soalan Q29 / Go to Q29)
26. Berapa umur awda ketika mula-mula menghisap produk tembakau setiap hari?
How old were you when you first started smoking daily?
Umur / Age tahun / years (Pergi ke S28 / Go to Q28) Tidak Tahu / Don’ Know 666 (Pergi ke S27 / Go to Q27)
27. Ingatkah kira-kira telah berapa lama dahulu? Catit 1 jawapan sahaja
Do you remember long ago it was? Record only 1 answer
Tahun / Years (Pergi ke S28 / Go to Q28) Atau / Or Bulan / Months Atau / Or Minggu / Weeks Atau / Or Don’t know 666
28. Secara purata, berapa batang produk tembakau yang awda hisap setiap hari?
On average, how many of the following do you smoke each day?
Rokok buatan Kilang / Manufactured cigarettes Rokok gulung / Hand-rolled cigarettes Paip penuh tembakau / Pipes full of tobacco Cerut / Cigars, cheroots, cigarillos Others (specify) / lain-lain (nyatakan) ______(Pergi ke S32 / If other, go to Q32) Kegunaan C. STATUS MEROKOK / SMOKING STATUS Resmi Official Use
29. Jika Tidak bagi S24, dahulunya pernah menghisap tembakau setiap hari?
If No to Q24, in the past, did you ever smoke daily?
1. Ya / Yes (Pergi ke S30 / Go to Q30) 2. Tidak / No (Pergi ke S32 & 33 / Go to Q 32 & 33)
30. Berapa umur awda ketika berhenti merokok setiap hari?
How old were you when you stopped smoking daily?
Umur / Age tahun / years (Pergi ke S32 / Go to Q32) Tidak Tahu / Don’ Know 666 (Pergi ke S31 / Go to Q31)
31. Berapa lama dahulu awda berhenti merokok setiap hari? Catit 1 jawapan sahaja
How long ago did you stop smoking daily? Record only 1 answer
Tahun / Years (Pergi ke S32 / Go t Atau / Or Bulan / Months Atau / Or Minggu / Weeks Atau / Or Don’t know 666
32. Jika Tidak bagi S29, adakah awda pada masa ini menggunakan apa jua jenis tembakau tanpa asap (seperti jenis hidu, sisha, kunyah, pinang)?
If No to Q29, do you currently use any smokeless tobacco (such as snuff, sisha, chewing tobacco, betel)?
1. Ya / Yes 2. Tidak / No
33. Adakah awda menggunakan apa jua jenis tembakau tanpa asap (seperti jenis hidu, sisha kunyah, pinang) setiap hari?
Do you currently use any smokeless tobacco (such as snuff, sisha, chewing tobacco, betel) daily?
1. Ya / Yes 2. Tidak / No Kegunaan D. AKTIVITI FISIKAL / PHYSICAL ACTIVITY Resmi Official Use
AKTIVITI DALAM PEKERJAAN / ACTIVITY AT WORK
34. Adakah pekerjaan awda melibatkan aktiviti berintensiti berat (seperti mengangkat barang-barang berat, menggali, mengorek, pembinaan – Rujuk Senarai) yang menyebabkan pernafasan atau degupan jantung yang cepat dan berterusan untuk sekurang-kurangnya 10 minit?
Does your work involve vigorous-intensity activity that causes large increase in breathing or heart rate like (carrying or lifting heavy loads, digging or construction – Refer List) for at least 10 minutes continuously?
1. Ya / Yes 2. Tidak / No (Pergi ke S37/ Go to Q37)
35. Lazimnya dalam seminggu bekerja, berapa hari awda melakukan aktiviti berintensiti berat?
In typical week how many days do you do vigorous-intensity activities as part of your work?
Jumlah Hari / Number of Days
36. Lazimnya dalam sehari bekerja, berapa lama masa awda melakukan aktiviti berintensiti berat?
On a typical day at work, how much time do you spent doing vigorously-intensity activities?
Jam / Hours Minit / Minutes
37. Adakah pekerjaan awda melibatkan aktiviti berintensiti sederhana (seperti berjalan cepat, mengangkat barang-barang – Rujuk Senarai) yang menyebabkan pernafasan atau degupan jantung bertambah cepat dan berterusan sekurang-kurangnya 10 minit?
Does your work involve moderate-intensity activity (such as brisk walking or carrying light loads – Refer Lists) that causes small increase in breathing or heart rate for at least 10 minutes continuously?
1. Ya / Yes 2. Tidak / No (Pergi ke S40/ Go to Q 40) Kegunaan D. AKTIVITI FISIKAL / PHYSICAL ACTIVITY Resmi Official Use
38. Lazimnya dalam seminggu bekerja, berapa hari awda melakukan aktiviti berintensiti sederhana?
In typical week how many days do you do moderate-intensity activities as part of your work?
Jumlah Hari / Number of Days
39. Lazimnya dalam sehari bekerja, berapa lama masa awda melakukan aktiviti berintensiti sederhana?
On a typical day at work, how much time do you spent doing moderate-intensity activities?
Jam / Hours Minit / Minutes
PERJALANAN DARI SATU TEMPAT KE TEMPAT LAIN / TRAVEL TO AND FROM PLACES
40. Adakah awda berjalan atau berbasikal berterusan untuk sekurang-kurangnya 10 minit jika pergi dari satu tempat ke tempat lain?
Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places?
1. Ya / Yes 2. Tidak / No (Pergi ke S 43/ Go to Q 43)
41. Lazimnya dalam seminggu bekerja, berapa hari awda berjalan atau berbasikal berterusan untuk sekurang-kurangnya 10 minit jika pergi dari satu tempat ke tempat lain?
In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places?
Jumlah Hari/ Number of Days
42. Lazimnya dalam sehari, berapa lama masa awda berjalan atau berbasikal untuk perjalanan?
On a typical day how much time do you spend walking or bicycling for travel on a typical day?
Jam / Hours Minit / Minutes Kegunaan D. AKTIVITI FISIKAL / PHYSICAL ACTIVITY Resmi Official Use
AKTIVITI REKREASI / RECREATIONAL ACTIVITIES
43. Adakah awda ikut serta dalam sukan, senaman atau riadah berintensiti berat (seperti berlari, bolasepak, squash - Rujuk Senarai) yang menyebabkan pernafasan atau degupan jantung yang kuat dan berterusan untuk sekurang-kurangnya 10 minit?
Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that causes large increases in breathing or heart rate (like running or football – Refer List) for at least 10 minutes continuously?
1. Ya / Yes 2. Tidak / No (Pergi ke S46 / Go to Q46)
44. Lazimnya dalam seminggu, berapa hari awda ikut serta dalam sukan, senaman atau riadah berintensiti berat (seperti berlari, bolasepak, squash-Rujuk Senarai) yang menyebabkan pernafasan atau degupan jantung yang cepat dan berterusan untuk sekurang-kurangnya 10 minit?
In a typical week, on how many days do you do vigorous-intensity sports, fitness or recreational (leisure) activities?
Jumlah Hari/ Number of Days
45. Lazimnya dalam sehari, berapa lama masa awda melakukan sukan, senaman atau riadah berintensiti berat?
How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?
Jam / Hours Minit / Minutes Kegunaan D. AKTIVITI FISIKAL / PHYSICAL ACTIVITY Resmi Official Use
46. Adakah awda ikut serta dalam sukan, senaman atau riadah berintensiti sederhana (seperti berjalan laju, berbasikal, renang, volleyball – Rujuk Senarai) yang menyebabkan pernafasan atau degupan jantung bertambah dan berterusan untuk sekurang-kurangnya 10 minit?
Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that causes small increase in breathing or heart rate such as brisk walking, cycling, swimming, volleyball Refer List) for at least 10 minutes continuously?
1. Ya / Yes 2. Tidak / No (Pergi ke S49 / Go to Q49)
47. Lazimnya dalam seminggu, berapa hari awda ikut serta dalam sukan, senaman atau riadah berintensiti sederhana(seperti berjalan laju, berbasikal, renang, volleyball-Rujuk Senarai)?
In a typical week, on how many days do you do moderate-intensity sports, fitness or recreational (leisure) activities?
Jumlah Hari/ Number of Days
48. Lazimnya dalam sehari, berapa lama masa awda melakukan sukan, senaman atau riadah berintensiti sederhana?
How much time do you spend doing moderate-intensity sports, fitness or recreational activities on a typical day?
Jam / Hours Minit / Minutes
49. Lazimnya dalam sehari, berapa lama masa awda gunakan untuk duduk, sandar, rehat? (tidak termasuk menonton televisyen dan tidur)
How much time do you usually spend sitting, resting or reclining on a typical day? (excluding watching television and sleeping)
Jam / Hours Minit / Minutes
50. Lazimnya dalam sehari, berapa lama masa awda gunakan untuk menonton televisyen?
How much time do you usually spend watching television on a typical day?
Jam / Hours Minit / Minutes Kegunaan E. SEJARAH KENAIKAN TEKANAN DARAH / HISTORY OF RAISED BLOOD PRESSURE Resmi Official Use
51. Bilakah kali terakhir awda diperiksa tekanan darah oleh doktor atau pekerja kesihatan?
When was your blood pressure last measured by a doctor or health worker?
1. Dalam masa 12 bulan yang lalu / Within the past 12 months 2. 1-5 tahun lalu / 1-5 years ago 3. Bukan dalam masa 5 tahun yang lalu / Not within past 5 years 4. Tidak pernah / Never 666. Tidak tahu / Don’t know 999. Tidak berkenaan / Not applicable
52. Dalam masa 12 bulan lalu, pernahkan doktor atau pekerja kesihatan memaklumkan awda yang tekanan darah awda naik atau awda menghidap tekanan darah tinggi?
During the past 12 months, have you been told by a doctor or health worker that you have high blood pressure or hypertension?
1. Ya / Yes 2. Tidak / No 666. Tidak Tahu / Don’t know
53. Adakah awda pada masa ini menerima rawatan / nasihat berikut dari doktor atau pekerja kesihatan?
Are you currently receiving any of the following treatments / advice from a doctor or health worker?
Ya / Yes Tidak / No 1. Ubat-ubatan / Pil dimakan dalam 2 minggu lalu Tablets / Pills you have taken in the last 2 weeks
2. Rawatan Diet Khusus Special Prescribed Diet
3. Nasihat / rawatan kurangkan berat badan Advice / treatment to lose weight
4. Nasihat / rawatan berhenti merokok Advice / treatment to stop smoking
5. Nasihat mulakan / tambahkan senaman Advice to start or do more exercise
Kegunaan E. SEJARAH KENAIKAN TEKANAN DARAH / HISTORY OF RAISED BLOOD PRESSURE Resmi Official Use
54. Dalam masa 12 bulan lalu adakah awda pernah berjumpa perawat tradisi / kampung / alternatif untuk mengawal tekanan darah tinggi?
During the past 12 months have you ever seen a traditional healer for raised blood pressure or hypertension?
1. Ya / Yes 2. Tidak / No
55. Adakah awda pada masa ini memakan ubat-ubatan kampung / herba / rawatan tradisi untuk mengawal tekanan darah tinggi?
Are you currently taking any herbal or traditional remedy for high blood pressure?
1. Ya / Yes 2. Tidak / No Kegunaan F. SEJARAH DIABETIS / HISTORY OF DIABETES Resmi Official Use
56. Adakah awda pernah diperiksa kadar gula dalam darah dalam masa 12 bulan lalu?
Have you had your blood sugar measured during the past 12 months?
1. Ya / Yes 2. Tidak / No 666. Tidak Tahu / Don’t know 999. Tidak berkenaan / Not applicable
57. Dalam masa 12 bulan lalu, pernahkan doktor atau pekerja kesihatan memaklumkan kepada awda yang awda tinggi kadar gula dalam darah atau menghidap kencing manis atau diabetis?
During the past 12 months, have you ever been told by a doctor or health worker that your blood sugar level is high or have diabetes?
1. Ya / Yes 2. Tidak / No 666. Tidak Tahu / Don’t know
58. Untuk WANITA sahaja / For WOMEN only
Adakah awda pertama kali dimaklumkan tinggi kadar gula / diabetis semasa mengandung?
Were you first informed of your high blood sugar / diabetes when you were pregnant?
1. Ya / Yes (Pergi ke S59 / Go to Q59) 2. Tidak / No (Pergi ke S60 / Go to Q60) 666. Tidak Tahu / Don’t know (Pergi ke S60 / Go to Q60) 999. Tidak berkenaan / Not applicable (Pergi ke S60 / Go to Q60)
59. Untuk WANITA sahaja / For WOMEN only
Adakah tingggi kadar gula / diabetis itu berterusan selepas awda melahirkan anak?
Did the high blood sugar / diabetes continue immediately after your baby was born?
1. Ya / Yes 2. Tidak / No 666. Tidak Tahu / Don’t know 999. Tidak berkenaan / Not applicable Kegunaan F. SEJARAH DIABETIS / HISTORY OF DIABETES Resmi Official Use
60. Adakah awda pada masa ini menerima rawatan / nasihat berikut dari doktor atau pekerja kesihatan?
Are you currently receiving any of the following treatments / advice from a doctor or health worker? Ya / Yes Tidak / No
1. Suntikan Insulin / Insulin Injection
2. Makan ubat, dimakan dalam masa 2 minggu lalu Oral Drug (Medication) you have taken in the last 2 weeks
3. Rawatan Diet Khusus Special Prescribed Diet
4. Nasihat / rawatan kurangkan berat badan Advice or treatment to lose weight
5. Nasihat / rawatan berhenti merokok Advice / treatment to stop smoking
6. Nasihat mulakan / tambahkan aktiviti Advice to start or do more exercise
61. Dalam masa 12 bulan lalu pernahkah awda berjumpa perawat tradisi / kampung / alternatif untuk mengawal tinggi kadar gula dalam darah atau diabetis?
During the past 12 months have you ever seen a traditional healer for raised blood sugar or diabetes?
1. Ya / Yes 2. Tidak / No
62. Adakah awda pada masa ini memakan ubat-ubatan kampung / herba / rawatan tradisi untuk mengwal tinggi kadar gula dalam darah atau diabetis?
Are you currently taking any herbal or traditional remedy for high blood sugar or diabetes?
1. Ya / Yes 2. Tidak / No Kegunaan G. SEJARAH TINGGI KOLESTEROL DALAM DARAH / Resmi HISTORY OF HIGH BLOOD CHOLESTEROL Official Use
63. Adakah awda pernah diperiksa kadar kolesterol dalam darah oleh doktor atau pekerja kesihatan dalam masa 12 bulan lalu?
Have you had your blood cholesterol measured by a doctor or health worker during the past 12 months?
1. Ya / Yes 2. Tidak / No 666. Tidak Tahu / Don’t know 999. Tidak berkenaan / Not applicable
64. Dalam masa 12 bulan lalu, pernahkan doktor atau pekerja kesihatan memaklumkan kepada awda yang kadar kolesterol dalam darah awda tinggi?
During the past 12 months have you ever been told by a doctor or health worker that you have high blood cholesterol?
1. Ya / Yes 2. Tidak / No 666. Tidak Tahu / Don’t know
65. Adakah awda diberikan rawatan / nasihat berikut oleh doktor atau pekerja kesihatan untuk mengawal tinggi kolesterol dalam darah?
Have you been given by a doctor or health worker the following medication / advice for your high blood cholesterol? Ya / Yes Tidak / No 1. Ubat-ubatan / Pil dimakan dalam 2 minggu lalu Tablets / Pills you have taken in the last 2 weeks
2. Rawatan Diet Khusus Special Prescribed Diet
3. Nasihat / rawatan kurangkan berat badan Advice or treatment to lose weight
4. Nasihat / rawatan berhenti merokok Advice / treatment to stop smoking
5. Nasihat mulakan / tambahkan aktiviti Advice to start or do more exercise Kegunaan H. SEJARAH TINGGI KOLESTEROL DALAM DARAH / Resmi HISTORY OF HIGH BLOOD CHOLESTEROL Official Use
66. Dalam masa 12 bulan lalu pernahkah awda berjumpa perawat tradisi / kampung / alternatif untuk mengawal kolesterol tinggi dalam darah?
During the past 12 months have you ever seen a traditional healer for raised blood cholesterol?
1. Ya / Yes 2. Tidak / No
67. Adakah awda pada masa ini memakan ubat-ubatan kampung / herba / rawatan tradisi untuk mengawal kolesterol tinggi dalam darah?
Are you currently taking any herbal or traditional remedy for high blood cholesterol?
1. Ya / Yes 2. Tidak / No Kegunaan I. STATUS KESIHATAN / HEALTH STATUS Resmi Official Use
68. Dalam masa 12 bulan lalu pernahkah doktor atau pekerja kesihatan memaklumkan kepada awda yang awda menghidapi masaalah kesihatan berikut?
During the past 12 months, have you ever been told by a doctor or health worker that you have the following medical problems?
Ya / Yes Tidak / No 1. Buah Pinggang / Kidney Problems
2. Angin Ahmar / Stroke
4. Barah / Cancer
5. Jantung Koronari / Heart Disease
6. Ampus / Asthma
7. Kurang darah / Anemia
SILA SERTAKAN BERSAMA INI SALINAN KAD RAWATAN PERUBATAN PLEASE STAPLE HERE COPY OF TREATMENT CARD
Salinan Kad disertakan / Copy of Card stapled
Did not bring card / Kad Tidak dibawa
Tiada Kad Rawatan / No Treatment Card Kegunaan J. IMEJ DIRI / BODY IMAGE Resmi Official Use
69. Adakah awda merasakan diri awda? / Do you consider yourself to be?
1. Kurang Berat Badan / Underweight 2. Berat Badan Bersesuaian / Acceptable Weight 3. Lebih Berat Badan / Overweight 4. Sangat Berlebihan Berat Badan / Very Overweight 5. Tidak memikirkan berat badan / No consideration on weight 666. Tidak tahu / Don’t Know
70. Pandangan awda terhadap berat badan awda sekarang?
How do you feel about your weight now?
1. Sangat Berpuas Hati / Very Satisfied 2. Agak Berpuas Hati / Somewhat Satisfied 3. Tidak Berpuas hati / Not Satisfied 4. Tidak Peduli / Don’t care 666. Tidak tahu / Don’t Know
71. Adakah awda sekarang berdiet untuk mengurangkan berat badan?
Are you currently on a weight reducing diet?
1.Ya / Yes 2. Tidak / No Kegunaan K. MAKANAN TAMBAHAN / FOOD SUPPLEMENTS Resmi Official Use
72. Adakah awda pada masa ini mengambil makanan tambahan berikut?
Are you currently taking the following food supplements?
Ya / Yes Tidak / No 1. Vitamins & Galian / Vitamins & Minerals
2. Makanan Herba / Herbal Supplements
4. Makanan untuk mengurangkan berat badan/ Supplements for weight loss
5. Makanan untuk menambahkan berat badan/ Supplements for weight gain L: SUKATAN ANTROPOMETRI / ANTHROPHOMETRIC MEASUREMENTS
Weight • kg 73 Measurer Code
Height • cm 74 Measurer Code
Waist • cm 75 Measurer Code
M: TEKANAN DARAH / BLOOD PRESSURE
76 Measurer code
1st read 2nd read Average read Systolic
Diastolic N. RINGKASAN KEKERAPAN MAKANAN / SHORT FOOD FREQUENCY
Untuk Kegunaan Pejabat Sahaja / For Official Use Only
Kod / Tandatangan / Tarikh / Date Code Signature HH/BB/TTTT DD/MM/YYYY
Penemuduga / Interviewer
Penyunting / Verifier
Penyemak Kod / Code Examiner
Pengisi Data / Data Entered By Kegunaan N. RINGKASAN KEKERAPAN MAKANAN / SHORT FOOD FREQUENCY Resmi Official Use
77. Dalam masa seminggu, lazimnya dalam berapa hari awda makan buah-buahan?
In a typical week, how many days do you eat fruits?
Jumlah Hari / Number of Days Tidak Tahu / Don’t know 666
78. Berapa jumlah hidanganbuah awda makan dalam salah satu hari tersebut ?
How many servings of fruits do you eat on one of those days? (1 serving = 1 medium piece / 2 small pieces / 1 cup of diced pieces)
Jumlah Hidangan / Number of servings Tidak Tahu / Don’t know 666
79. Dalam masa seminggu, lazimnya dalam berapa hari awda makan sayur-sayuran?
In a typical week, how many days do you eat vegetables?
Jumlah Hari / Number of Days Tidak Tahu / Don’t know 666
80. Berapa jumlah hidangansayur-sayuran awda makan dalam salah satu hari tersebut ?
How many servings of vegetables do you eat on one of those days? (1 serving = half cup of cooked vegetables / 1 cup of salad vegetable)
Jumlah Hidangan / Number of Servings Tidak Tahu / Don’t know 666
81. Secara purata, berapa kali awda mengambil makanan yang tidak disediakan di rumah dalam seminggu (contoh: sarapan, makan tengah hari / malam)? satu jawapan sahaja
On average, how many meals per week do you eat that were not prepared at home? By meal I mean breakfast, lunch or dinner. one answer only
Number:
Don’t Know 666 Kegunaan N. RINGKASAN KEKERAPAN MAKANAN / SHORT FOOD FREQUENCY Resmi Official Use
82. Berapa kerapkah awda bersarapan pagi? satu jawapan sahaja
How often do you eat breakfast? one answer only
1. Setiap hari / Everyday 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know
83. Susu jenis apakah yang awda selalu ambil? satu jawapan sahaja
What type of milk do you usually have? one answer only
1. Susu Penuh Krim / Full Cream Milk 2. Susu Rendah Lemak / Low 3. Susu Skim / Skimmed Milk 4. Susu Pekat Manis / Sweet Condensed milk 5. Krimer/ Non Dairy Creamer 6. Lain-lain / Others 7. Tidak minum / Don’t drink 666. Tidak tahu / Don’t know
84. Berapa kerapkah awda minum minuman bergas / berkarbonat / kordial / sirap / minuman sukan? satu jawapan sahaja
How often do you drink fizzy/ carbonated drinks / cordials / syrups / sports drink? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know Kegunaan N. RINGKASAN KEKERAPAN MAKANAN / SHORT FOOD FREQUENCY Resmi Official Use
85. Berapa kerap awda minum minuman jenis 2 dalam 1, 3 dalam 1 atau 4 dalam 1? satu jawapan sahaja
How often do you drink instant drinks such as 2 in 1 drinks, 3 in 1 drinks or 4 in 1 drinks? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know
86. Minyak jenis apakah yang selalu awda gunakan untuk mamasak makanan di rumah? satu jawapan sahaja
What type of cooking oil is most often used for meal preparation in your household? one answer only
1. Vegetable or coconut oil (Palm oil based / minyak kelapa) 2. Polyunsaturated Oil (Sesame / Corn / Sunflower / Soya bean ) 3. Monounsaturated oil (Buah Zaitun / Olive oil / Peanut oil / Canola) 4. Mentega atau Minyak sapi / Butter or Ghee 5. Margarine 6. Lain-lain / Others 7. Tidak guna / Don’t use 666. Tidak tahu / Don’t know
87. Berapa kerapkah awda memakan makanan yang mengandungi santan? satu jawapan sahaja
How often do you eat food containing coconut milk? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know Kegunaan N. RINGKASAN KEKERAPAN MAKANAN / SHORT FOOD FREQUENCY Resmi Official Use
88. Berapa kerapkah awda makan kuih-muih melayu seperti Bingka, Kusui, Seri Muka, cucur, cakoi, karipap, popia, kelupis, pie dan lain-lain? satu jawapan sahaja
How often do you eat Malay Kuih such as bingka, kusui, seri muka, cucur, cakoi, karipap, popia, kelupis, pie and others? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know
89. Berapa kerapkah awda makan makanan segera seperti Ayam Goreng / Piza/ Chips / Burger / Sosej / Nuget? satu jawapan sahaja
How often do you eat fast food such as Fried Chicken / Pizza/ Chips / Burger/ Sausage / Nugget? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know
90. Berapa kerapkah awda makan Nasi Katok? satu jawapan sahaja
How often do you eat Nasi Katok? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know Kegunaan N. RINGKASAN KEKERAPAN MAKANAN / SHORT FOOD FREQUENCY Resmi Official Use
91. Berapa kerapkah awda makan Tongking Ayam / Sayap Ayam / Kulit Ayam? satu jawapan sahaja
How often do you take Chicken Tail / Wings / Skin? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3.Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know
92. Berapa kerapkah awda makan mee segera? satu jawapan sahaja
How often do you eat instant noodles? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know
93. Berapa kerapkah awda makan makanan snek seperti keropok? satu jawapan sahaja
How often do you snack on crisps / keropok? one answer only
1. Kali sehari / Times per day 2. Kali seminggu / Times per week 3. Kali sebulan / Times per month 4. Jarang - Tidak makan / Rarely – Never 666. Tidak tahu / Don’t know O. INGATAN PENGAMBILAN MAKANAN 24 JAM / DIETARY INTAKE : 24 HOUR DIET RECALL
Untuk Kegunaan Pejabat Sahaja / For Official Use Only
Kod / Code Tandatangan / Tarikh / Date
Signature HH/BB/TTTT
DD/MM/YYYY
Penemuduga / Interviewer
Penyunting / Verifier
Penyemak Kod / Code Examiner
Pengisi Data / Data Entered By
Tick
Isnin Mon
Hari Makanan Dimakan Selasa Tue Day Food Taken Rabu Wed
Khamis Thur
Jumaat Fri
Sabtu Sat
Ahad Sun O. INGATAN PENGAMBILAN MAKANAN 24 JAM / DIETARY INTAKE : 24 HOUR DIET RECALL
Meal / Time Brief / Short Detailed description of food & drinks Amount Food of Meal taken description of food eg parts of meat, cooking methods, types of oil, types of fat, types of milk, Code & drinks recipes, ingredients, household measures, size, raw, cooked etc
O. INGATAN PENGAMBILAN MAKANAN 24 JAM / DIETARY INTAKE : 24 HOUR DIET RECALL
Meal / Time Brief / Short Detailed description of food & drinks Amount Food of Meal taken description of food eg parts of meat, cooking methods, types of oil, types of fat, types of milk, Code & drinks recipes, ingredients, household measures, size, raw, cooked etc
P. UJIAN DARAH / BIOCHEMISTRY
SLIP KEPUTUSAN DARAH HENDAKLAH DISERTAKAN BERSAMA BIOCHEMISTRY RESULT PRINTOUT TO BE STAPLED HERE
1. Full Blood Count 2. HbA1C 3. Lipid Profile 4. Creatinine 5. Fasting Blood Sugar 6. Oral GTT (Only for non-diabetics) Appendix B
2nd National Health and Nutritional Status Survey and Diabetes Prevalence Sub-Study
TRAINING MANUAL
2010 Table of Contents
Page No.
Background 141
The Survey 142
Overview of the Procedure 143
Step 1 : Arrival and Registration 144
Step 2 : Height, Weight and Waist Circumference Station 145
Step 3 : Blood Pressure Station 145
Step 4 : Diabetes Screening Station 146
Step 5 : Venepuncture Station 147
Step 6 : Oral Glucose Tolerance Test (RED Station) 148
Step 7 : Questionnaires 149
Step 8 : Venepuncture Post OGTT 149
Step 9 : Exit Check 150
Quality Control 151
Height 152
Weight 153
Waist Circumference 154
Blood Pressure (Sitting) 156
Blood Specimen Handling for RIPAS Hospital Laboratory 158
140 Background
Ministry of Health, Brunei Darussalam in line with the 1992 World Declaration and Plan of Action for Nutrition on gathering food and nutrition information, and in surveillance and early warning activities, recognises the necessity to periodically carry out a nation-wide survey on the health and nutritional status of the population. National Nutritional Survey is also one of the Ministry’s National Strategic Plan, 2010. National Surveys among children under five years old and pregnant women was carried out in 1995 while the 1st National Nutritional Status for all ages was conducted in 1996.
The 2nd NHANSS started in March 2009 and will be carried out for the next 3 years covering all age-groups across the country and is aimed at:
1. Identifying from the population the existing dietary habits, food consumption, eating pattern and their relation to health status.
2. Analysing the adequacy and inadequacy of nutrient intake from the diet and identifying the at risk groups.
3. Assessing changes in trends and comparisons in dietary habits and health and nutritional status over the decade and comparing with regional and international communities.
4. Serving as baseline in the development of national nutritional policies, prioritisation and implementation of strategies and action plans on nutritional and health programmes.
5. Monitoring intakes against National Dietary Guidelines for Bruneians and assist as the basis in the establishement of Recommended Dietary Intake (RDI) / Recommended Dietary Allowance (RDA) across the population in the country.
6. Providing current evidence based information on diet-nutrition-disease relationship thus providing basis of recommendations and actions plans for targeted groups and as the basis for health promotion strategies.
7. Establishing information towards the development in food safety related policy and guidelines and in provision of food related to food security: production, manufacture, importation and sales.
141 The Survey
Similar to the previous nutiriton survey, the 2nd NHANSS will be a cross-sectional survey conducted with representative samples among all age groups of the population conducted in all the 4 districts. It is conducted in two stages:
Stage 1 A sample size of about 1300 children from birth to 5 years of age was surveyed at Maternal Child Health Clinics. Samples were drawn from attendances at these clinics.
Stage 2 An estimated sample size of 4000 participants age ≥ 5 years to 5 years of age will be surveyed. Sample will be drawn from population structure in mukims and villages as per JPKE consultation.
In stage 2, questionnaire and anthropometric measurements will be performed on all participants. Pathology tests will only be done for participants ≥ 20 years olds.
Questionnaire will include: 1. Demographics 2. Socio-economic status 3. Medical / smoking status 4. Knowledge, Attitudes and Practices on Health & Nutrition 5. Physical Activity Pattern 6. Anthropometric measurements 7. Breastfeeding practices and multiple dietary assessment 8. Biochemical measurements on older children and adults
Diabetes Prevalence Study will be conducted as a substudy to the 2nd NHANSS. This phase of the study will include all participants ≥ 20 years to 75 years of age. The objectives of the Diabetes Prevalence Study are:
1. To describe the current epidemiology of diabetes and abnormal glucose tolerance and related risk factors in Brunei Darussalam.
2. To assess the relationship of risk factors in diabetes and abnormal glucose tolerance.
3. To estimate the extent of diabetes complications in subjects with known and newly diagnosed diabetes.
4. In the longer term, to provide data for the development of appropriate intervention programmes for diabetes and related risk factors in Brunei Darussalam.
5. To evaluate the effectiveness of any intervention programmes implemented.
142 Overview of the Procedure
Staff Survey staff will include the health offcers, research assistants, diabetes nurse educators, dietitians, doctors and laboratory staff from Ministry of Health.
Supervision Team Questionnaires 1. Hjh Masni Hj Ibrahim Senior Dietitian Head, Community Nutrition Division Ministry of Health 2. Hjh Roseyati DP Hj Yaakub Senior Dietitian Community Nutrition Division Ministry of Health
Anthropometric measurements and blood sampling 1. Dr Alice Yong Specialist Endocrinologist RIPAS Hospital 2. Dr Haslinda Hassan Specialist Endocrinologist and Head RIPAS Hospital
Laboratory Services 1. Dr Hjh Noorainun Hj Md Yusof Specialist Haematologist Head, Clinical Laboratory RIPAS Hospital 2. Lim Swee Yien Senior Scientific Officer Clinical Chemistry Laboratory Services RIPAS Hospital
143 Specimens All specimens collected during the survey will be sent to the Biochemistry and Haematology Laboratory of RIPAS Hospital for analysis. Blood specimens for Creatinine, Lipids and blood glucose will be spun on site and stored in insulated cool bags prior to transfer to the laboratories for analysis. The results will be returned to Dr Alice Yong and Dr Haslinda Hassan.
The Survey Procedure The Survey involves 9 steps. The following pages provide a list of: • The 9 Steps • The staff involved • A brief job description • A list of the required equipment an supplies, and • Instructions for specific assessments conducted during the Survey
Please read this carefully and ask Dr Alice Yong or Dr Haslinda Hassan if you are not sure what your role is.
Please Note
We expect that it will take at least 2 ½ hours for each person to complete the assessments and complete a glucose tolerance test. For those who do not need an OGTT, it will take at least 1 hour.
STEP 1 : Arrival and Registration Staff : 2 Health Officers
Job Description
• Greet participants and explain the purpose of the survey
• Confirm that the participant is fasting. If the participant is not fasting, participant can still proceed with all other steps apart from biochemistry / blood taking. A new appointment is to be given to participant for blood tests only.
• Explain where the toilets are.
• Double check the participant’s name, address, IC number against the registry for the day. Match the participant to the given serial no (Babcd).
• Put NHANSS sticker on participant to identify those who are there for purpose of survey only (as opposed to accompanying friend / family member). Write the serial no (Babcd) on the sticker with a permanent marker.
• For participants ≥20 years of age, place the questionnaire booklet and blood form in the clear folder. Ensure that the number on participant, questionnaire booklet and blood form (for those ≥20 years of age) is the same.
144 • Direct participant to Height, Weight and Waist Circumference Station.
• When the last participant is done, help out with other station as required.
STEP 2 : Height, Weight and Waist Circumference Station Staff : 2 Research Assistants
Job Description
• Check participant’s Serial No / ID
• Measure and record participant;s height in cms and weight in kgs without shoes and without heacy clothing. [BMI is calculated when data is entered later]. Enter participant’s weight and height to the nearest one decimal point (kg) in Section L, Question numbers 73 and 74 respectively on page 24 of the questionnaire booklet.
• Measure waist at the mid-point between the bottom of rib cage and top of hip bones in cms. Enter participant’s waist circumference to the nearest one decimal point (cm) in Section L, Question number 75 on page 24 of the Questionnaire booklet.
• Direct participant to blood pressure [BP] testing station.
• When last participant is done, help out at other station as required.
STEP 3 : Blood Pressure Station Staff : 1 Research Assistant and 1 Health Officer - from STEP 1
Job Description
• Check participant’s Serial No / ID
• Measure blood pressure [the participant must be sitting down and every effort should be made to ensure they are rested for at least 5 mins and calm prior to checking the BP]
• Record the blood pressure on the participant’s questionnaire booklet in Section M, Question number 76 on page 24 under 1st read.
• Measure BP again ONE more time (5 minutes apart) and record in Section M, Question number 76 on page 25 under 2nd read.
• The “average read” will be calculated at data entry.
• Direct the participant to the Diabetes Screening Station.
• When last participant is done, help out at other station as required
145 STEP 4 : Diabetes Screening Station Staff : 2 Diabetes Nurse Educators
Job Description
• Check participant’s Serial No / ID
• Request to see participant’s treatment card or “PHY” card if available. Identify those participants who have unknown diabetes status. Unknown diabetes status are those who ANSWER NO to the following: 1. Are you pregnant (female participants)? 2. Are you taking insulin or oral hypoglycaemic agents for diabetes? (For participants who are unsure of their medication, show them the display sample of insulin and oral hypoglycaemic agents)
Only those who answer NO to both the above questions will need a 75gm Oral Glucose Tolerance Test (75gm OGTT) and will be identified with ared dot for that day. Participants who are on “diet control” diabetes also require an OGTT.
• Place red dot on participant’s NHANSS sticker and front page of Questionnaire booklet for participants who have been identified for OGTT.
• There will be some participants who are on metformin for other indications other than diabetes e.g. Polycystic Ovarian Syndrome and Non-Alcoholic Fatty Liver Disease, severe insulin resistance with obesity. If in doubt, do not perform OGTT on such participants on that day (i.e. no blood tests). However, participants will proceed with questionnaires.
• Make an appointment for OGTT. Advise participants to DISCONTINUE METFORMIN for 2 weeks prior to OGTT and to have a normal diet 3 days before the OGTT. Give participant an information sheet with new appointment date and above instructions.
• When last participant is done, help out at the RED STATION.
Perform Oral Glucose Tolerance Test if: Participant is not pregnant and diabetes status is unknown Participant has “diet-controlled” diabetes Participant is unsure of diabetes status and is not on metformin for other indications
Oral Glucose Tolerance Test is not required if: Participant is pregnant or has documented diabetes and is already treated with insulin or any oral hypoglycaemic agent
Pregnant Women Pregnant women are excluded from the NHANSS and Diabetes Sub-Study and would have been identified by field workers during home visits. If any women are unsure about their pregnancy status, they should have a pregnancy test done on site. Test strips are available.
146 STEP 5 : Venepuncture Station Staff : 2 Laboratory Technicians
Job Description
• Check participant’s Serial No / ID
• Perform venepuncture and collect blood as indicated below:
Blood test Bottle Amount Tube labeling
1. Full Blood Count & HbA1c 3ml x 2 EDTA 2. Lipid profile 3ml 3. Creatinine Yellow gel tube
4. Fasting Blood Glucose 2ml F
5. Oral GTT (2 h glucose) Grey tube fluoride 2ml 2h
• Order of draw for multiple tube collections Blood must be drawn in a specific order to avoid cross-contamination of additives between tubes. Clinical and Laboratory Standards Institute (CLSI) recommended the order of draw as follows:
Yellow gel tube Centrifuge 1
EDTA (purple top) 2 Do not centrifuge
Oxalate / Fluoride (grey top) Centrifuge 3
• Label each tube IMMEDIATELY with laboratory barcode label and write the participant’s name and IC, again checking that the ID is correct.
• Centrifuge only the grey and yellow gel tubes.
• Place the tubes in biochemistry and haematology racks as follow:
Biochemistry Laboratory Haematology Laboratory
EDTA (purple) tube EDTA (purple) tube Yellow gel tube Grey tube (F) and another Grey tube (2H) – in those who underwent OGTT
147 • Place the biochemistry racks in the insulated cool bag for keeping prior to transfer to laboratory.
• For participants having an OGTT, direct the participant to the OGTT or RED station.
• Safely dispose of blood contaminated material and venepuncture needles immediately.
• Assist with checking samples and help out at RED Station.
Please Note 1
Only participants with a RED DOT on their NHANSS sticker are for Oral Glucose Tolerance Test
Please Note 2
Frequent handwashing, wearing gloves and safe disposal of blood contaminated waste is ESSENTIAL
STEP 6 : Oral Glucose Tolerance Test (RED Station) Staff : 1 Research Assistant
Job Description
• Check participant’s Serial No / ID
• Check participant has a red dot on the NHANSS sticker and double check that glucose load is NOT given to those with diabetes who are receiving insulin or other oral hypoglycaemic agents.
• Give glucose drink as soon as possible after first blood collection. This should be drunk within 5 minutes. Immediately record the time that participant is required to have the 2-hour glucose blood test on the white oblong sticker. Stick this sticker on the NHANSS sticker of the participant.
• Tell the participant the time the 2-hour glucose blood test needs to be done and ask him/her to notify any staff if not called for repeat venepuncture in 2 hours or as specified on the sticker.
• If possible, participant should be recalled back to the VENEPUNCTURE STATION 5 minutes before the 2 hours is up.
• Direct participant to go to questionnaire station.
Please Note
1. You will need to watch the time carefully to make sure the second blood sample is collected 2 hours after the glucose drink is taken. 2. You will need to make sure that the questionnaires are done while the patient is waiting in the OGTT waiting area for the second blood collection.
148 STEP 7 : Questionnaires Staff : 4 Dietitians / Nutritionists / 3 Research Assistants
Job Description
• Check participant’s Serial No / ID
• Research assistants to administer questionnaire on pages 1-23 and the dietitians / nutritionists will administer Short Food Frequency on pages 26-30 and 24 hour Dietary Recall on pages 31-38.
• Check that all questions are completed.
• Check that participant has finished other assessments.
• NOT FOR OGTT – direct participant to Exit Check.
• FOR OGTT – ask participant to remain resting in OGTT waiting area until the 2 hour venepuncture is due.
Please Note
1. The questionnaires must be administered by one of the Survey Team – they cannot be given to the patient to fill out. 2. You can clarify or repeat questions if the patient does not understand but you cannot answer for them. 3. All questions must be answered.
STEP 8 : Venepuncture post OGTT Staff : 2 Laboratory Technicians
Job Description
• Check participant’s Serial No / ID
• Perform second venepuncture 2hrs after the Glucose was given at time as specified on the white oblong sticker.
• Label second blood sample as 2h
• Follow blood specimen handling procedure.
• Ensure the venepuncture site is clean and not bleeding.
• Place a bandaid / plaster over the site.
• Direct participant [with their completed Questionnaire booklet] to the Exit Check.
149 STEP 9 : Exit Check Staff : 2 Health Officers (same as in STEP 1)
Job Description
• Check participant’s Serial No / ID
• Check that all the 38 pages in the Questionnaire Phase 2 booklet are present and completed and ALL participant details and ALL the tests have been done.
• Ensure that the status on the “Treatment Card” section on Page 21 was filled in. If the section “copy of card stapled” was ticked, please ensure that the photocopy was attached to the Questionnaire booklet.
• Offer to remove the NHANSS sticker from participant’s clothing.
• Thank participant for participating and direct them to the Refreshments Station.
• Collect folder from the participant.
(Please ensure that each box has been ticked when you have confirmed that the item being checked is completed).
CHECK QUESTIONNAIRE FORM d Check that the Serial No on the participant’s sticker is the same as the Serial No / ID number on the questionnaire booklet. d Check that each question on the questionnaire booklet has been completed.
PRIOR TO DISCHARGE OF THE PARTICIPANT d Check that the participant feels well and that the venepuncture site is not bleeding. If the participant is unwell, or the venepuncture site is bleeding, let the “Officer-in-charge” know. d Check that the participant is given a souvenir for his / her participation in this Survey.
150 Quality Control 1. Infection control standards must be adhered to at all times throughout the Survey.
2. Disposal of sharps must only be disposed into approved standard sharp containers.
3. Centrifuge (Kubota) must be wiped down with 70% alcohol solution at the end of each session.
4. Weighing scales must be calibrated at the beginning of each session or following any occurrence that may have damaged the instrument, ie the instrument is dropped.
5. Tape measures should be replaced if they appear stretched or the measurement markings are unclear.
6. Electronic syphgmomanometers must be in good condition with each use. Ensure that they are running on electricity and not battery whenever possible.
151 Height Guide for use : Measure height in centimeters (cm) to one decimal place.
Data Collection Methods Measurement Protocol : The measurement of height requires a vertical metric rule, a horizontal headboard, and a non-compressible flat even surface on which the participant stands.
The graduations on the metric rule should be at 0.1 cm intervals, and the metric rule should have the capacity to measure up to at least 210 cm.
Figure 1 Figure 2
The participant should be measured without shoes (i.e. is barefoot or wears thin socks) and wears little clothins so that the positioning of the body can be seen (Figure 1)
The participant stands with weight distributed evenly on both feet, heels together, and the head positioned so that the line of vision is at right angles to the body. The arms hang freely by the sides. The head, back, buttocks and heels are positioned vertically so that the buttocks and the heels are in contact with the vertical board. (Figure 1) To obtain a consistent measure, the participant is asked to inhale deeply and stretched to their fullest height.
Move the participant’s head so that the Frankfort Plane is in horizontal position (parallel to the floor). The Frankfort Plane (Figure 2) is an imaginary line passing through the external ear canal and across the top of the lower bone of the eye socket, directly under the eye. This position is important if an accurate reading is to be obtained. The movable headboard is brought onto the top of the head with sufficient pressure to compress the hair.
Measures : All equipment, whether fixed or portable should be checked prior to each measurement session to ensure that both the headboard and floor (or footboard) is 90 degrees to the vertical rule.
152 Weight Guide for use : Measure weight in kilograms.
Data Collection Methods Equipment : Scales should have a resolution of 0.1kg and should have the capacity to weigh up to at least 200kg. measurement labels should be clearly readable. Manufacturers’ guidelines should be followed with regard to the transportation of the scales.
Measurement Protocol : Weight should be measured to the nearest 0.1kg. The participant stands over the centre of the weighing instrument, with the body weight evenly distributed between both feet. Heavy jewellery should be removed and pockets emptied. Light indoor clothing can be worn, excluding shoes, and jackets. Turn on the scale by pressing the button on the front: “8888” appears in the display. When “0.0” appears, have participant step on the scale and stand still until a stable reading is displayed. Wait for the weight to stabilize on one recording.
Note : The collection of anthropometric measurements, particularly in those who are overweight or obese or who are concerned about their weight should be performed with great sensitivity and without drawing attention to an individual’s weight.
153 Waist Circumference Guide for use : A participant’s waist circumference is measured half way between the inferior margin of the last rib and the crest of the ilium in the mid-axillary plane.
Data Collection Methods Measurement Protocol : The measurement of waist circumference requires a narrow (<7 mm wide), flexible tape measure. The graduations on the tape measure should be at 0.1 cm intervals and the tape should have the capacity to measure up to 200 cm. Measurement labels should be clearly readable.
The participant should remove any belts and heavy outer clothing. Measurement of waist circumference should be taken over at most one layer of light clothing. Ideally the measure is made directly over the skin.
The participant stands comfortably with weight evenly distributed on both feet, and the feet separated about 25-30 cm. the arms should hang loosely at the sides. Posture can affect waist circumference.
154 Waist Circumference The waist (Figure 1) is located as the point midway between the iliac crest (hip bone) and the costal margin (lower rib). An approximate indicator of this level may be ascertained by asking the participant to bend sideways (to see or feel rib and/or hip).
Figure 2
The measurement is taken midway between the inferior margin of the last rib and the crest of the ilium, in the mid- axillary plane.
The circumference is measured at the end of normal expiration. The tape is snug, but does not compress underlying soft tissues. The measurer is positioned by the side of the subject and reads the tape. The measurement is recorded at the end of a normal expiration to the nearest 0.1 cm.
Note : The collection of anthropometric measurements, particularly in those who are overweight or obese or who are concerned about their weight should be performed with great sensitivity and without drawing attention to an individual’s weight.
155 Blood Pressure (Sitting) Guide for use : Routine blood pressure measurement has two components – systolic and diastolic measurement. The systolic blood pressure reflects the maximum pressure to which the arteries are exposed. The diastolic blood pressure reflects the minimum pressure to which the arteries are exposed. Blood pressure measurement is given in mmHg. The Omron Automatic Blood Pressure Monitor uses the oscillometric method of blood pressure management. At the push of the button, the monitor automatically fills the cuff with air, starts deflation, and then displays the systolic and diastolic readings on an extra large display panel.
Data Collection Methods Cuff Size : No matter what type of non invasive technology is used, the most important factor in accurately measuring blood pressure is the use of an appropriately sized cuff. The ‘cuff size’ refers only to the inner inflatable bladder, not the cloth covering. A technique to establish an appropriate cuff size is to choose a cuff bladder that covers 80% to 100 % of the circumference of the arm. The table below shows the recommended bladder dimensions for blood pressure cuffs.
Arm circumference Bladder width Bladder length Cuff name at mid point (cm) (cm) 24 - 32 Adult 13 24
32 - 42 Wide adult 17 32
Method : 1. The participant should be sitting for at least 5 minutes before the blood pressure is recorded. Participants should not exercise within half an hour of the measurement being taken.
2. Wrap appropriately sized cuff snugly around upper arm with the centre of the bladder of the cuff positioned over the brachial artery and the lower border of the cuff about 2 cm above the bend of the elbow. The Green Marker on the cuff should lie over the brachial artery on the inside of the arm.
The tube should run down center of arm approximately even with middle finger. (Figure 1a)
156 Figure 1a Figure 1b
3. Ensure cuff is at heart level (Figure 1b), whatever the position of the participant.
4. Record the systolic and diastolic readings.
5. If the reading is not obtained on the first attempt, wait 30 seconds before repeating the procedure in the same arm.
6. When measurement is complete, the monitor displays the blood pressure and automatically deflates the cuff.
7. Wait another 5 minutes before taking another blood pressure measurement.
8. There is no need to remove the cuff in between taking the first and second reading.
9. Always measure first and second reading on the same arm, preferably the left arm.
157 Blood Specimen Handling for RIPAS Hospital Laboratory
Guide for use : Preparation of blood specimen immediately following the collection of blood in the yellow and grey tubes. DO NOT SPIN EDTA (PURPLE) TUBE Data Collection Methods 1. Collect blood sample in yellow gel tube and grey tube
2. Completely and gently invert at least 8 times.
Centrifuge within 30 minutes of collection.
3. Place in Centrifuge and spin for a minimum of 10 minutes at 3000 RPM (approx 1,000 x g)
CENTRIFUGE
4. After spinning, return the yellow spun tube in individual participant’s biohazard bag with the other purple tube. Place the spun grey tube in the rack.
5. Check the ID number on all specimen tubes are the same.
6. Place racks containing specimen in insulated cool bags until transferred to RIPAS Hospital laboratory.
7. Store at 4OC until analysed.
8. Analyse within 48 hours. 158 PLEASE REMEMBER….. If you are in doubt about anything at all
w If you’re not sure what to do w If you don’t understand how to do any of the procedures w If you can not answer a participant’s question or don’t know how to advise him / her w If you suspect you have made an error eg in labeling samples or recording information
You must immediately contact the “Officer-in-charge” for that day. The “Officer-in-charge” can direct any unanswered question to either DR ALICE YONG OR DR HASLINDA HASSAN
159 General Physical Activities Defined by Level of Intensity Appendix C The following is in accordance with CDC and ACSM guidelines.
Moderate activity+ Vigorous activity+ 3.0 to 6.0 METs* Greater than 6.0 METs* (3.5 to 7 kcal/min) (more than 7 kcal/min)
Walking at a moderate or brisk pace of 3 to 4.5 mph on a Racewalking and aerobic walking - 5 mph or faster level surface inside or outside, such as Jogging or running • Walking to class, work, or the store; Wheeling your wheelchair • Walking for pleasure; Walking and climbing briskly up a hill • Walking the dog; or Backpacking • Walking as a break from work. Mountain climbing, rock climbing, rapelling Roller skating or in-line skating at a brisk pace Walking downstairs or down a hill Racewalking – less than 5 mph Using crutches Hiking Roller skating or in - line skating at a leisurely pace
Bicycling 5 to 9 mph, level terrain, or with few hills Bicycling more than 10 mph or bicycling on steep Stationary bicycling – using moderate effort uphill terrain Stationary bicycling – using vigorous effort
Aerobic dancing – high impact Aerobic dancing – high impact Water aerobics Step aerobics Water jogging Teaching an aerobic dance class
Calisthenics – light Calisthenics – push-ups, pull-ups, vigorous effort Yoga Karate, judo, tae kwon do, jujitsu Gymnastics Jumping rope General home exercises, light or moderate effort, getting Performing jumping jacks up and down from the floor Using a stair climber machine at a fast pace Jumping on a trampoline Using a rowing machine – with vigorous effort Using a stair climber machine at a light-to-moderate pace Using an arm cycling machine – with vigorous effort Using a rowing machine – with moderate effort
Weight training and bodybuilding using free weights, Circuit weight training Nautilus - or Universal-type weights
Boxing – punching bag Boxing – in the ring, sparring Wrestling – competitive
Ballroom dancing Professional ballroom dancing – energetically Line dancing Square dancing – energetically Square dancing Folk dancing – energetically Folk dancing Clogging Modern dancing, disco Ballet
Table tennis – competitive Tennis – singles Tennis – doubles Wheelchair tennis 160 Golf, wheeling or carrying clubs – – – –
Softball – fast pitch or slow pitch Most competitive sports Basketball – shooting baskets Football game Coaching children’s or adults’ sports Basketball game Wheelchair basketball Soccer Rugby Kickball Field or rollerblade hockey Lacrosse
Volleyball – competitive Beach volleyball – on sand court
Playing Frisbee Handball – general or team Juggling Racquetball Curling Squash Cricket – batting and bowling Badminton Archery (non-hunting) Fencing
Downhill skiing – with light effort Downhill skiing – racing or with vigorous effort Ice skating at a leisurely pace (9 mph or less) Ice-skating – fast pace or speedskating Snowmobiling Cross-country skiing Ice sailing Sledding Tobogganing Playing ice hockey
Swimming – recreational Swimming – steady paced laps Treading water – slowly, moderate effort Synchronized swimming Diving – springboard or platform Treading water – fast, vigorous effort Aquatic aerobics Water jogging Waterskiing Water polo Snorkeling Water basketball Surfing, board or body Scuba diving
Canoeing or rowing a boat at less than 4 mph Canoeing or rowing – 4 or more mph Rafting – whitewater Kayaking in whitewater rapids Sailing – recreational or competition Paddle boating Kayaking – on a lake, calm water Washing or waxing a powerboat or the hull of a sailboat
Fishing while walking along a riverbank or while wading – – – – in a stream – wearing waders
Hunting deer, large or small game Pheasant and grouse hunting – – – – Hunting with a bow and arrow or crossbow – walking 161 Horseback riding – general Horsebackriding – trotting, galloping, jumping, or in Saddling or grooming a horse competition Playing polo
Playing on school playground equipment, moving about, Running swinging, or climbing Skipping Playing hopscotch, 4-square, dodgeball, T-ball, or Jumping rope tetherball Performing jumping jacks Skateboarding Roller-skating or in-line skating – fast pace Roller-skating or in-line skating – leisurely pace
Playing instruments while actively moving; playing in a Playing a heavy musical instrument while actively marching band; playing guitar or drums in a rock band running in a marching band Twirling a baton in a marching band Singing while actively moving about – as on stage or in church
Gardening and yard work: raking the lawn, bagging grass Gardening and yard work: heavy or rapid shoveling or leaves, digging, hoeing, light shoveling (less than 10 (more than 10 lbs per minute), digging ditches, or lbs per minute), or weeding while standing or bending carrying heavy loads Planting trees, trimming shrubs and trees, hauling Felling trees, carrying large logs, swinging an ax, branches, stacking wood hand-splitting logs, or climbing and trimming trees Pushing a power lawn mower or tiller Pushing a nonmotorized lawn mower
Shoveling light snow Shoveling heavy snow
Moderate housework: scrubbing the floor or Heavy housework: moving or pushing heavy
Source: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. Promoting physical activity: a guide for community action. Champaign, IL: Human Kinetics, 1999. (Table adapted from Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Medicine and Science in Sports and Exercise 1993;25(1):71-80. Adapted with technical assistance from Dr. Barbara Ainsworth.)
162 Self Reported Health Status (Medical Conditions) Appendix D for Respondents Aged 19 Years and Above (n=1524)
Percentage of Self-Reported Medical Conditions
5.1
3.1
1.8
0.8 0.4 0.4
Kidney Problem Stroke Cancer Heart Disease Asthma Anaemia
Burden of self-reported medical conditions as previously informed to survey respondents by a doctor or health worker in the past 12 months of the survey was shown in the figure above.
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