Mal J Nutr 2: 112-126, 1996 Anthropometry, dietary patterns and nutrient intakes of Malaysian estate workers Chee SS1, Zawiah H1, Ismail MN1, and Ng KK2 1 Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur. 2 Amway (Malaysia) Sdn. Bhd., Petaling Jaya, Selangor. ABSTRACT Studies were carried out in two estates in Kedah and Johor to characterize the anthropometry and dietary patterns of 334 (169 females, 165 males) Malaysian estate workers. Subjects were Malay and Indian adults (aged 18 to 60 years) engaged in various work activities including rubber tappers, palm fruit harvesters, field supervisors and workers in the estate factories. Anthropometric results showed that the prevalence of overweight (26% in men, 25% in women) and obesity (5% in men, 11% in women) were higher compared to prevalence of underweight (11% in men, 9% in women) in these workers despite being engaged in moderate to heavy activities. The dietary intake pattern revealed that the main sources of calories in the diet were rice, cooking oil and sugar. Major sources of protein in the Malay diet were anchovies and fish whilst in the Indian diet protein was provided by salted fish, anchovies, eggs, fish, and pulses. The consumption of poultry, meat and dairy products were low for both ethnic groups. The dietary intakes of a subsampel of 108 normal weight subjects (56 females, 52 males) were recorded for 3 days. The results showed that the mean energy intake was 8.44 ± 2.12 MJ in males and 6.48 ± 1.29 MJ in females. The contribution of calories from protein, fat and carbohydrate were 13%, 22% and 60% in males and 12%, 23% and 65% in females, respectively. Alcohol intake was found to contribute five percent of energy in the diet of the Indian male subjects. Calcium, iron, vitamin A, thiamin, riboflavin and niacin intake were below 66% of the Malaysian RDA, particularly amongst the women. Income appeared to have a significant correlation with energy and iron intakes of the female workers as well as thiamin, niacin and riboflavin intakes of the male workers. There is a need for improving the quality of the dietary intakes of these workers as well as nutrition education on the prevention of obesity and its consequences. INTRODUCTION Oil palm and rubber are the main crops grown in Malaysia, covering a total land area of 1.8 million hectares for rubber and 13.47 million hectares for oil palm in 1990 (Department of Statistics, 1991). Some of these are planted in estates which employ workers who not only work but live in these plantations with their families. In the early 1980’s, the estate workers were generally regarded as being poorly paid and living in an environment without proper basic amenities and plaqued with problems of undernutrition and diseases (O’Holohan, 1994). High prevalence of protein-energy malnutrition, anemia, worm Chee SS, Zawiah H, Ismail MN & Ng KK infestations and vitamin deficiences have been reported amongst estate communities (Kandiah & Lim, 1977; Sinniah et al., 1992). The growth of estate children was found to be the poorest compared to children of the urban disadvantaged and rural sectors (Singh, 1992). Chandrasekharan and Marimuthu (1980) reported various nutrient inadequacies in the dietary intakes of estate families. However, to date there is a limited amount of data on dietary intakes of estates workers in Malaysia. Presently, acts of Parliament such as the Workers Minimum Standards of Housing and Amenities Act, 1990 have been passed to ensure the safety and health of estate workers. Proper housing, basic amenities, hospital and medical treatment as well as schools will have to be provided by estate operators for the workers and their families (O’Holohan, 1994). The objectives of this study were to characterize the current status through anthropometry and dietary pattern evaluations and to examine the influence of the dietary patterns on nutrient intakes of the estate workers. METHODS The study was conducted in two estates located in Ladang Sungai Dingin, Karangan, Kedah and Ladang Ulu Remis, Layang-layang, Johor. This study was part of a larger study on the energy requirements of adults in Malaysia (Ismail et al., 1994). Subjects Subjects were obtained from volunteers who lived in the estates. They were adults (aged 18-60 years) and they comprised of rubber tappers, palm fruit harvesters, field supervisors and workers in the seed germinating and palm fruit processing factories. Those who held administrative or managerial positions and foreign workers were excluded from this study. Anthropometric measurements were carried out in a total of 334 workers (169 females, 165 males) from the two estates. A subsample of 108 healthy subjects (57 females, 52 males) with normal Body Mass Index (BMI ; 18.5 -24.9 kg/in2) WHO (1990) were then selected for the food intake study. Method Body weight was measured in light clothings, without shoes to the nearest 0.1 kg using a SECA beam balance (Model 713 Germany) calibrated with a known weight. Height was measured to the nearest 0.1 cm using the height attachment to the SECA beam balance. Body mass index (kg/in2) was calculated for each individual. Skinfold measurements were taken at four sites; tricep, bicep, subscapular and suprailiac using the Harpenden calipers (British Indicators, UK), following the method of Durnin and Rahaman (1967). Body fat percentages were then calculated using the formula by Durnin and Womersley (1974). A pre-tested questionnaire was used to assess dietary pattern. The questionnaire included socio- economic characteristics and a food frequency list consisting of 37 food items. Frequency of Nutritional status of estate workers food consumption was classified using a 5-point scale ranging from 5 = daily, 4 = 2-3 times a week, 3 = once a week, 2 = once a month, 1 = never. A score was calculated for each of the food items using an equation adapted from Reaburn, Krondl & Lau (1979) and Zaitun & Terry (1990) Score = R S + R S + R S + … R S 1 1 2 2 3 3 5 5 5 where S …S are the scale ratings and R …R are the percent respondents selecting a rating, and 1 5 1 5 5 is the maximum scale rating. Energy and nutrient intakes of 52 male and 56 female subsample individuals were measured using a 3-day food record method, as described by Marr (1971). Food intake was recorded in household measures. Field assistants were employed at various study sites to assist in home visits. Foods eaten were recorded and checked for completeness, portion sizes and ingredients used. The weight of the foods was estimated based on the portion sizes using a list of common weight of foods which was previously compiled. Intakes were calculated using the Malaysian Food Composition Table (Tee et al, 1988) and were compared with the Malaysian RDA (Teoh, 1975). The researchers lived in the community for an average of 60 days to complete the study. Frequency distribution analysis, Student t-test and Pearson correlation coefficient test were performed on the data. A statistical probability of less than 0.05 was considered significant. RESULTS AND DISCUSSION Background information about the estates The estates were located at a distance of less than 10 km from the small town of Karangan in Kedah and Layang-layang in Johor. Ladang Sungai Dingin in Kedah covered an area of 10,000 acres and cultivated mainly with rubber and oil palm while Ladang Ulu Remis in Johor covered an area of 6,000 acres and planted mainly with oil palm and cocoa. There were also seed germinating and palm fruit processing factories in both the estates. Both estates provided single storey terrace houses with two bedrooms for the workers and their families, which were equipped with tap water and electricity. There were sundry shops in both estates which sell dry provisions as well as vegetables, fruits, fish, and other daily produce. Several food and beverage stalls are found in the estates operating from dawn until late night. Both the estates have a hospital along with other facilities such as creches and schools for the workers children. Description of sample Selected demographic characteristics of the 334 subjects are presented in Table 1. The subjects comprised of Indians (74% males, 73% females) and Malays (26% males, 27% females). Fifty- eight percent of the male subjects worked as rubber tappers and palm fruit harvesters, whilst another 23% were factory workers and 19% were field supervisors. Majority of the female Chee SS, Zawiah H, Ismail MN & Ng KK subjects (71%) were rubber tappers whilst the remainder 29% were factory workers. Majority of the subjects had only primary level education. The mean age of the subjects studied was 37 ± 9 years for females and 38 ± 7 years for males. The mean household income of the subjects was RM 488 ± 190 per month for males and RM 430 ±176 per month for female subjects. Family size ranged from 3 to 6 with a mean of 3.6. Sixty percent of the monthly income was spent on food items and the rest on amenities and education expenses for the children. Table 1. Selected demographic characteristics of subjects Characteristics Males Females n = 165 n = 169 Ethnicity Malay 43 45 Indian 122 124 Category of work Field workers (palm fruit harvesters and/or rubber tapppers) 95 120 Field supervisors 32 - Factory workers (seed germinating and/or palm fruit processing) 38 49 Level of education None 4 39 Primary 95 91 Secondary 66 39 Mean age (years ± SD) 38 ± 7 37 ± 9 Mean household income ± SD RM488 ± 190 RM430 ± 176 The frequency distribution of the subjects based on income is shown in Table 2. Among the Malay subjects, 46.4% of the males and 47.5% of the females were earning less than the Poverty Line Income of RM 370 (Government of Malaysia, 1990) whilst among the Indians, the figures were 28.7% and 38% for the males and females, respectively. However, no significant difference was found between mean household income and ethnicity. In terms of household possessions, the subjects owned most of the basic necessities. Over 90% of the subjects had gas stove, radio and television while a lesser proportion had a refrigerator (74%), video recorder (39%), motorcycle (84%) and bicycle (30%). None of the subjects owned any land while 20% of them reared chickens for domestic consumption. Anthropometry The physical characteristics of the total sample of 334 subjects are shown in Table 3. The weight of the male subjects ranged from 38.4 kg - 93.9 kg with a mean of 62.2 ± 11.2 kg . As for the female, the weight ranged from 31.4 to 89.4 kg with a mean of 55.2 ± 10.8 kg. The mean heights of the males was 1.64 ± 0.06 m and 1.52 ± 0.05 in for the females. The mean BMI of the males Nutritional status of estate workers (23.1 ± 3.8 kg/m2) and females (23.8 ± 4.4 kg/m2) was within the range for normal individuals (WHO, 1990). Mean percent body fat values for the males (22.2 ± 5.7%) and the females (33.7% ± 5.6 %) indicated that the male and female subjects were generally not lean but fell within moderate body fat levels (Durnin and Womersley, 1974). No significant difference in anthropometric measurements was noted between the Malays and Indians. Figure 1. Geometric means for skinfold thicknesses by age group, males (skinfolds: bi: biceps; tri: triceps; sca: subscapular; sil: suprailiac; clf: medial calf). Figure 2. Geometric means for skinfold thicknesses by age group, females (skinfolds: bi: biceps; tri: triceps; sca: subscapular; sil: suprailiac; clf: medial calf). Chee SS, Zawiah H, Ismail MN & Ng KK Table 2. Income distribution of subjects Income Males (n = 165) Females (n = 169) Malay Indian Malay Indian Ethnic n = 43 n = 122 n = 45 N = 124 Below RM370 46.4% 28.7% 47.5% 38.0% RM371 - RM500 32.2% 46.7% 52.5% 33.7% RM501 - RM1000 21.4% 24.6% 0% 28.3% Mean ± SD 406 ± 119 500 ± 176 355 ± 111 426 ± 82 (range) (200-700) (200-905) (140-600) (310-500) Table 3. Physical characteristics of 334 subjects (mean ± SD)* n Age (years) Weight (kg) Height (m) BMI (kg/m²) Body fat (%) Males Malay 43 37 ± 10 63.5 ± 13.7 1.63 ± 07 23.8 ± 4.4 22.3 ± 6.3 Indian 122 40 ± 9 61.7 ± 10.2 1.64 ± 0.06 22.8 ± 3.6 22.2 ± 5.6 Total 165 39 ± 9 62.2 ± 11.2 1.64±0.06 23.1 ± 3.8 22.2 ± 5.4 (18-58) (38.4-9.39) (1.48-1.79) (14.6-32.6) (4.6-36.3) Females Malay 45 36 ± 12 55.3 ± 11.2 1.51 ± 0.06 24.2 ± 4.7 34.1 ± 6.6 Indian 124 37 ± 8 54.9 ± 10.6 1.52 ± 0.05 23.6 ± 4.3 33.5 ± 5.4 Total 169 37 ± 9 55.2 ± 10.8 1.52 ± 0.05 23.8 ± 4.4 33.7 ± 5.7 (18-57) (31.4-89.4) (1.37-1.67) (15.6-38.2) (18.7-46.7) * Figures in parentheses indicate range The BMI of these adults were divided into various categories as shown in Table 4. About 57.6% of the males could be classified as normal (BMI 18.5 - 24.9), 11% underweight (BMI below 18.5), 26% overweight (BMI 25.0-29.9) and 5% were obese (BMI 30.0 and above). In females, about 55.6% were normal, 8.9% underweight, 24.9% overweight and 10.6 % obese. Results also revealed that the prevalence of overweight and obesity were higher compared to prevalence of underweight amongst these estate workers. Overweight and obesity were most prevalent amongst those working in the factories who led a largely more sedentary lifestyle. However, in the men and women engaged in moderate to heavy work such as rubber tapping and fruit harvesting, overweight (20% in men, 25% in women) and obesity (4% in men, 8% in women) was still prevalent. Dietary pattern The food use frequency score of 37 food items is shown in Table 5. The higher scores indicate more frequent intake of these foods. The range of scores were divided arbitarily into three food frequency categories: highly consumed foods (score = 80.0 - 100.0), moderately consumed foods (score = 60.0 - 79.9), less consumed foods (score = 59.9 and below). Nutritional status of estate workers Table 4. Percentage subjects at various categories of BMI Underweight Normal weight Overweight Obese (BMI below 18.5 (BMI 18.5-24.9 (BMI 25.0-29.9 (BMI >30.0 kg/m²) kg/m²) kg/m²) kg/m²) Males Field workers (n=95) 9.5 66.3 20.0 4.2 Field supervisors (n=32) 21.0 50.0 21.0 8.0 Factory Workers (n=38) 3.1 40.6 50.0 6.3 Total (n=165) 10.9 57.6 26.1 5.4 Females Field worker (n=120) 9.2 57.5 25.0 8.3 Factory workers (n=49) 8.2 51.0 24.5 16.3 Total (n=169) 8.9 55.6 24.9 10.6 Table 5. Food use frequency score of subjects Malay (n = 77) Indian (n = 268) Food Score Food Score A. Highly consumed foods (Score: 80.0 - 100.0) Rice 100.0 Rice 100.0 Cooking oil 99.4 Cooking oil 98.2 Sugar 94.6 Ground/instant coffee 96.6 Ground/instant coffee 93.0 Salted fish 94.8 Dried anchovies 91.2 Sugar 88.0 Vegetables 87.6 Vegetables 82.8 Fresh fish 85.8 Full cream milk powder 80.8 B. Moderately consumed foods (Score: 60.0 — 79.9) Coconut milk 70.0 Anchovies 73.8 Eggs 68.0 Eggs 70.4 Flour products 65.2 Fresh fish 68.4 Bread 64.4 Bread 67.6 Fruits 63.2 Chocolate beverage 66.4 Soyabean products Legumes & pulses 66.2 (tofu, tempe, fucuk) 62.4 Coconut milk 62.8 Cordial drinks 61.8 Noodles 62.6 Sweetened condensed milk 60.8 Fruits 60.2 C. Less consumed foods (Score: 20.0 - 59.9) Noodles 55.6 Fresh milk 59.2 Poultry 55.4 Yogurt 55.3 Chee SS, Zawiah H, Ismail MN & Ng KK Canned sardines 50.0 Soyabean products Dried, salted fish 49.8 (tofu, tempe, fucuk) 55.6 Chocolate beverages 49.2 Canned sardines 52.4 Roots and tubers 47.8 Flour products 52.2 Carbonated drinks 43.0 Roots & tubers 47.2 Legumes & pulses 41.0 Poultry 46.4 Shellfish 39.0 Evaporated milk 45.6 Beef 38.2 Sweetened condensed milk 45.2 Organ meat 37.8 Carbonated drinks 41.0 Margarine/butter/jams/kaya 32.0 Shellfish 36.8 Full cream milk 30.8 Margarine/butter/jams/kaya 31.4 Evaporated milk 28.8 Cordial drinks 32.0 Fresh milk 24.0 Alcohol 32.3 Cheese 20.0 Organ meat 29.4 Yogurt 20.0 Mutton 23.8 Pork meat 20.0 Pork meat 23.2 Alcohol 20.0 Cheese 20.5 Rice, cooking oil and sugar were in the highly consumed food category for both the Malays and Indians, indicating these are the major sources of calories in the diet of these estate workers. Rice, being the staple diet in Malaysia, had the highest score of 100.0 and was consumed daily by 100% of these subjects. About 99% of the subjects use cooking oil daily and the major cooking oil used was palm oil. Sugar provided another source of calories as it was consumed daily by 85% of the Malay subjects and 81% of the Indian subjects. Sugar was mainly added into coffee, another highly consumed beverage. It was a habitual practice of the workers to bring along large tumblers of coffee with sugar to drink while at work in the fields. Other energy providing sources were flour products and bread in the Malay diet whilst among the Indians, bread and noodles were moderately consumed as sources of energy. Dried anchovies provide a substantial source of protein in the Malay diet as it was categorized in the highly consumed food group with 88% of the population consuming it two to three times a week or daily. Anchovies were mostly added in vegetable dishes and it was a relatively affordable source of protein and calcium in the estate. Another major source of protein for the Malays was fish which was consumed by 90% of the subjects two to three times a week or on a daily basis. Among the Indians, major protein source reported was salted fish. Other sources of protein in the Indian diet were anchovies, eggs, fish and pulses but these were consumed moderately either once or two to three times a week. It is interesting to note the low consumption of poultry, beef, mutton, pork and shellfish which had low scores both among the Malays and Indians. The frequency of poultry consumption was reported as once a month by a majority (41%) of the Malay respondents and 68% of the Indian respondents. Beef was considered sacred to the Indians and both beef and mutton were eaten by the Malays on special occasions such as during celebrations. The low availability of shellfish observed being sold in the estate provision shop was the likely reason for the low consumption amongst the subjects. Coconut milk was moderately consumed by the respondents, reportedly taken several times a week by 41% of the Malays and 22% of the Indians. Vegetables were consumed once a week or more often by 90% of the Malay and Indian workers. Nutritional status of estate workers However, it should be noted that daily vegetable consumption was not practised by 71% of the Malay and 38% of the Indian workers. The subjects interviewed claimed that vegetables were costly and felt it was not economical to purchase as their children had a poor eating habit of avoiding vegetables. The type of vegetables frequently eaten were eggplant, okra, tomatoes and long beans which were added in dhall dishes by the Indians whilst the Malays consumed various types of green leafy vegetables. The consumption of fruits was moderate among the Malays and Indians with a score of 63.2 and 60.2, respectively. It was noted that consumption of fruits was seasonal and depended upon their availability. It is important to note that the consumption of milk and milk products was low, particularly amongst the Malays. About 81% of the Malays and 51% of the Indians reportedly never consumed milk at all. When taken in moderation, the Malays would prefer sweetened condensed milk while the Indians would frequently consume full cream milk. Consumption of other sources of calcium (besides anchovies) such as soyabean products and sardines were also low. Alcohol consumption was reported in the low use category. Only 16% of the Indian men and 5% of the Indian women reported that they consumed alcohol once a month or more often. This may well be under-reported due to the social stigma on alcohol consumption. Alcohol intake could contribute to excess energy and to the incidence of overweight observed among the Indian estate workers. Energy and nutrient intakes Table 6a and 6b show the mean energy and selected nutrient intake of 52 male and 56 female normal weight subjects. The mean energy intake was 8.44 ± 2.12 MJ (2032 ± 572 kcal) in males and 6.48 ± 1.29 MJ (1538 ± 384 kcal) in females. Fat provided an average of 22 ± 6 percent of the calories intake in men and 23 ± 8 percent in women. These figures are lower than the urban Malaysian diet which supplies 26% energy from fat as reported by Ng (1995). However, the contribution of energy from fat ranged from 15 to 55% among the females, and 14 to 34% in the male subjects indicating that there were individuals with high intakes of fat above the recommended levels of 15 - 30% by WHO (1990) for the prevention of chronic diseases. The mean percent contribution of carbohydrates to the daily energy intake was 60 ± 9 percent in male subjects and 65 ± 8 percent in female subjects. These figures are within the WHO (1990) recommendations of 50-70% kcal for total carbohydrate. The contribution of energy from protein was 13 ± 3 percent and 12 ± 3 percent in the men and women respectively, which were within the recommended level of 10-15 percent (WHO 1990). Alcohol was found to contribute about 5 percent of total energy intake in the diet of the Indian men. Table 6a also showed that the Malay male subjects had significantly lower intake of protein but higher intakes of fat and carbohydrate compared to the Indian male subjects. The intake of other nutrients, however were not significantly different. As for the female subjects (Table 6b), the Malay subjects had significantly higher intakes of protein, calcium, iron and vitamin A than the Indians. Chee SS, Zawiah H, Ismail MN & Ng KK Table 6a. Energy and nutrient intakes of 52 male subjects (mean ± SD) Nutrients Indian (n=40) Malay (n=12) Total mean (n=52) Energy (MJ) 8.11 ± 2.14 8.54 ± 1.88 8.44 ± 2.12 Protein (g) 58 ± 20 52 ± 26* 64 ± 23 % energy 12 ± 3 14 ± 3* 13 ± 3 Fat (g) 47 ± 21 60 ± 21* 51 ± 21 % energy 22 ± 7 24 ± 5 22 ± 6 Carbohydrate (g) 293 ± 71 352 ± 67* 307 ± 73 % energy 61 ± 11 62 ± 8 60 ± 9 Calcium (mg) 254 ± 115 333 ± 167 273 ± 130 Iron (mg) 10.9 ± 4.8 13.2 ± 6.9 11.5 ± 5.3 Vitamin A (µg RE) 480 ± 312 602 ± 277 503 ± 306 Thiamin (mg) 0.7 ± 0.3 0.8 ± 0.4 0.8 ± 0.3 Riboflavin (mg) 1.0 ± 0.6 1.0 ± 0.4 1.0 ± 0.5 Niacin (mg) 7.1 ± 2.7 7.6 ± 4.3 7.2 ± 3.1 Vitamin C (mg) 26 ± 19 38 ± 23 29 ± 20 * p < 0.05 Table 6b. Energy and nutrient intakes of 56 female subjects (mean ± SD) Nutrients Indian (n=46) Malay (n=10) Total mean (n=56) Energy (MJ) 6.35 ± 1.16 6.82 ± 1.68 6.48 ± 1.29 Protein (g) 44 ± 14 57 ± 16** 47 ± 15 % energy 12 ± 2 14 ± 2** 12 ± 3 Fat (g) 38 ± 17 44 ± 16 40 ± 18 % energy 22 ± 8 24 ± 4 23 ± 8 Carbohydrate (g) 251 ± 45 251 ± 61 251 ± 47 % energy 66 ± 8 62 ± 5 65 ± 8 Calcium (mg) 178 ± 82 284 ± 117** 198 ± 96 Iron (mg) 9.1 ± 4.2 11.0 ± 3.9* 8.6 ± 4.2 Vitamin A (µg RE) 323 ± 215 711 ± 413* 399 ± 296 Thiamin (mg) 0.5 ± 0.2 0.5 ± 0.2 0.5 ± 0.3 Riboflavin (mg) 0.6 ± 0.3 0.8 ± 0.3 0.7 ± 0.3 Niacin (mg) 5.0 ± 2.7 5.8 ± 1.2 5.3 ± 2.6 Vitamin C (mg) 20 ± 15 40 ± 25 25 ± 19 * p < 0.05 ** p < 0.001 Table 7 shows the percentage of subjects whose intake for various nutrients fall within selected RDA (Teoh, 1975) adequacy ranges. Energy intake was adequate in only 23% of the male subjects. However, more than 50% of the male subjects had intakes greater than 100% of the RDA for protein and iron. On the other hand, a high percentage of the male subjects had inadequate (less than 66% RDA) intake of riboflavin (58%), vitamin A (60%), calcium (62%) and in particular niacin (94%). These were reflected in the results of the dietary pattern survey where milk, milk products and meat consumption were reported to be low. Although the intake of vitamin C was adequate, 35% of the men had intakes of less than 66% of the RDA.