Child malnutrition cannot be judged by weight or appearance alone: Expert
PETALING JAYA: A child can appear healthy or even be overweight and still be malnourished, as a lack of essential nutrients may not be immediately visible, a clinical dietitian has warned.
UM Specialist Centre clinical dietitian Rozanna M Rosly said children could consume enough calories, or even too many, without getting the nutrients needed for healthy growth and development.
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“We cannot judge whether a child is well nourished simply by looking at body size. A child can consume too many calories and still not obtain enough essential nutrients,” she said.
Findings from the Seanuts II Malaysia study highlighted a “triple burden” of malnutrition, with undernutrition, overnutrition and micronutrient inadequacy occurring within the same population.
Among children aged six months to 12 years, 9.2% were overweight and 8.8% were obese, while undernutrition and micronutrient deficiencies were also recorded.
The study found anaemia in 40.3% of children under four, while 25.1% of those aged four to 12 had vitamin D insufficiency.
It also found that 79.4% of children did not meet the recommended dietary intake for calcium, while 94.8% fell short for vitamin D.
“This illustrates what is sometimes referred to as ‘hidden hunger’ – nutrient inadequacy may not be apparent simply by looking at a child,” Rozanna said.
She explained that children who consumed energy-dense foods, sweetened drinks and snacks could gain excess weight while still lacking essential micronutrients.
Malnutrition was not simply a matter of having too little food, as diet quality and variety were equally important.
Recent figures highlighted by Health Minister Datuk Seri Dr Dzulkefly Ahmad showed that among children under five in Kuala Lumpur, 23.4% were stunted, 12.4% were underweight, 8.1% were wasted and 7.5% were overweight.
Rozanna said the figures reinforced the need to look beyond being underweight when assessing malnutrition.
“The question is not only whether a child has enough food to eat, but whether that child is getting enough of the right foods and nutrients to grow and develop well,” she said.
Poor growth could result from several interacting factors, including medical, nutritional and social issues.
While poverty, food affordability and food insecurity remained important public health concerns, Rozanna cautioned against assuming that every malnourished child simply needed more calories.
She urged parents to pay attention to their child’s overall diet and growth over time. Some micronutrient deficiencies could initially cause few obvious symptoms.
Depending on the nutrient involved and the severity of the deficiency, parents might notice persistent tiredness, paleness, poor appetite, reduced activity or growth concerns.
However, she stressed that these symptoms were not specific to nutritional deficiencies and could have other causes.
Parents should seek professional advice rather than attempt to diagnose deficiencies based on appearance, particularly if their child had a highly restricted diet, consistently excluded entire food groups, experienced persistent feeding difficulties or was not growing as expected.
She added that even children with sufficient access to food could develop nutritional gaps if their diets lacked variety.
“Malaysia’s child malnutrition challenge is not simply about children having too little food. We are seeing undernutrition, overnutrition and micronutrient inadequacy at the same time.
“We therefore need to look beyond calories and body weight towards dietary quality, diversity and nutrient adequacy,” she said.
