Malaysia is a small developing country that located in Southeast Asia. Their neighbor countries are Thailand, Singapore, Indonesia, Brunei and also Philippines. Malaysia also known as a multicultural country due to many ethnic groups that exist in the country. Malays, Chinese and Indians are the three main races in the country. However, there are also many other indigenous and Bumiputra groups, such as Iban, Kadazan and Melanau, living in the country. According to WHO, the total population of Malaysia is 31,187,000 in the year of 2016. The growth rate of population is 2% from 1990 to 2015 and predicted to be 1.2% from 2015 to 2030. Besides that, the life expectancy at birth is 75 years old. For the final post, I decided to examine on how social determinant of health like food intake and early life effect type 2 diabetes in Malaysia using Epidemiological theory.
According to American Diabetes Association (ADA), type 2 diabetes means that your body is unable to use insulin properly. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy (CDC, n.d.). There are a few symptoms of diabetes which are urinating often, feeling very thirsty and hungry, extreme fatigue, blurry vision, cuts or bruises that are slow to heal and also tingling, pain, or numbness in the hands/feet (ADA, n.d.). Based on my finding, women are more vulnerable to diabetes due to the ricks factors that effecting diabetes. “Globally, there are 199 million women living with diabetes, and this disease is reported to be the ninth leading cause of death in women around the world, causing 2.1 million deaths each year” (Chin, 2017). Diabetes can actually cause several chronic diseases such as cardiovascular diseases, kidney diseases and also depression. Plus, women who diagnose with diabetes have higher risk of getting those chronic diseases. “Diabetic women have a two-fold increase in risk of coronary heart disease compared with their male counterparts, and nearly four times the risk for coronary heart disease death. There is evidence showing kidney disease is another complication of diabetes that affects women more than men as diabetic women normally suffer from lower level of estrogen, which is associated with kidney disease. Additionally, depression is reported twice as common in women, as it is in men, with diabetes” (Chin, 2017).
In Malaysia, the prevalence between males and females for both overall and undiagnosed diabetes mellitus is 9.1% and 9.2% respectively (Tee & Yap, 2017). There might be no significant different, but women recorded higher number of diabetes death. According to WHO (2016), among the ages of 30 – 69, females recorded 1,210 number of death while 1,170 among males. For the ages 70 and above, 1,260 for females while 1,070 for males – in the years of 2016. When it comes to type 2 diabetes, the two major factor that can lead to that disease is overweight and also obesity. Based on the statistics that given by WHO in the year of 2016, females recorded higher prevalence compared to males in both overweight and obesity. For overweight, prevalence among women is 38.3% while 36.2% for males. The prevalence of obesity in females is 15.3% while in males is 10.3%. We can see that women recorded much higher number in both obesity and overweight compared to men. When we talk about obesity and overweight, food intake will follow next as unhealthy dietary practices are the main causes of obesity and overweight. Based on results from The Malaysian Adult Nutrition Surveys (MANS) 2003 and 2014 reports, Malaysian adults had poor achievement (below 20%) of the recommended servings for the major food groups in the Malaysian Food Pyramid 2010 for three food groups which are fruits, vegetables, and legumes and nuts. Besides that, the percentage of consuming the recommended three servings of vegetables per daily dropped even further in the MANS 2014 to below 10%. Moreover, based on MANS 2014, the achievement for recommended servings for cereal and cereal products and tubers food group was just below 50%. According to the article by Tee & Yap (2017), “meat, poultry and egg was the only food group which had achievement above 50%, while the rest of the food groups had moderate achievement between 20 and 30%”. To conclude it, “Malaysian adults are not practicing the dietary guidelines of balance and moderation for the recommended intakes of major food groups” (Tee & Yap, 2017).
Based on the information above, using the Epidemiological theory, we can see the one of the causes of the increasing diabetes health issue is the food intake. Excess intake (also a form of malnutrition) contributes to cardiovascular diseases, diabetes, cancer, degenerative eye diseases, obesity and dental caries (Wilkinson, R. G., & Marmot, M., 2013). From the statistics that provided above, we see that Malaysian adult have the hard time to follow the dietary guidelines. This led to increasing the number of obesity and overweight. Thus, effect the number of diabetes. When we refer back to the statistics, we compare the females and males, females have the higher percentage in both obesity and overweight compared to males. This results in higher prevalence of diabetes among females compare to males. When it comes to food intakes, people definitely consume food all the times and they have the right to choose what type of food they want to eat, either a very healthy diet or not. As well know, what we eat will eventually affect our health. In this case, due to lack of practicing the dietary guidelines lead to obesity and overweight which the major risks of getting the type 2 diabetes.
“Observational research and intervention studies show that the foundations of adult health are laid in early childhood and before birth” (Wilkinson, R. G., & Marmot, M., 2013). Food trend always changed as time goes by. I believe that many parts of the world actually experience diet transition. The specific diet transition that I would likes to discuss is the transition towards western diet. Western diet is a modern dietary pattern that is generally characterized by high intakes of red meat, processed meat, pre-packaged foods, butter, fried foods, high-fat dairy products, eggs, refined grains, potatoes, corn (and high-fructose corn syrup) and high-sugar drinks. Like it was explained in the article by Wilkinson, R. G., & Marmot, M. (2013), it starts in early childhood. What they practice when they just a child will eventually be carried out to their adulthood. “Infant experience is important to later health because of the continued malleability of biological systems” (Wilkinson, R. G., & Marmot, M., 2013).
When it comes to obesity and overweight among the children, “It has been well documented that the majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries.” (Tee & Yap, 2017). In Malaysia, for overall prevalence of DM, there was a significant association with ethnicity. Malays (14.6%) have higher prevalence compared to Chinese (12%) (Tee & Yap, 2017). It is believed that there were significant differences in dietary patterns between Malay and Chinese adolescents. Based on the study by Abdullah N., Teo P. S. and Foo L. H. (2016), “comparisons of these food patterns across ethnicity showed that Malay adolescents had significantly higher scores for the Western-based food pattern (p < 0.001) and local-based food pattern (p < 0.001) compared to the Chinese participants (Table 4). In contrast, Chinese adolescents showed higher scores for the healthy-based food pattern than the Malay adolescents (p = 0.039)”. From the comparison between above, we can see that, Malay adolescents have high percentage of western diet in their daily life. Thus, this can continue on when they adult and might have large chance to have diabetes compares to Chinese. Moreover, we can see from statistic that I mention in the beginning where Malays have higher prevalence in diabetes compare to Chinese.
In conclusion, by using the Epidemiological theory, I able to prove the starting cause of diabetes health problem in Malaysia. The risk factor of having diabetes can be trace down to eating habit. Food intake definitely can effects our eating habit. Other than that, early life can determine our eating habits when we getter older. Asking question like “Where did this disease start?” and compare between population (Introducing theory 1: Epidemiological theory) help me find the answer.
WHO. (n.d.). Malaysia. Retrieved from https://www.who.int/countries/mys/en/
Chin, K. (2017). Women urged to take fight to Diabetes. Retrieved from https://www.nst.com.my/opinion/letters/2017/11/303349/women-urged-take-fight-diabetes
Tee, E., & Yap, R. (2017). Type 2 diabetes mellitus in Malaysia: current trends and risk factors. European Journal of Clinical Nutrition, 71(7), 844-849.
WHO. (2016). Retrieved from https://www.who.int/diabetes/country-profiles/mys_en.pdf?ua=1.
Wilkinson, R. G., & Marmot, M. (2003). Social determinants of health: The solid facts. Copenhagen: World health organization, Regional Office for Europe.
National Health and Morbidity Survey 2014: Malaysian Adult Nutrition Surveys. (2004). Institute for Public Health. Ministry of Health Malaysia.
National Health and Morbidity Survey 2013: Malaysian Adult Nutrition Surveys. (2004). Institute for Public Health. Ministry of Health Malaysia.
Abdullah N., Teo P. S. and Foo L. H. (2016). Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia.
Introducing theory 1: Epidemiological theory. Week 1 lecture
CDC. (n.d.). Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/type2.html
ADA. (n.d.). Type 2 Overview. Retrieved from https://www.diabetes.org/diabetes/type-2/symptoms