Socioeconomic Disparities and Its Association with Food Security, Diet Quality, and Growth among Malaysian Children Aged 6 Months to 12.9 Years

Pei Teng Lum¹Jasmine Siew Min Chia²Giin Shang Yeo¹See Meng Lim^1,3Sameeha MJ^1,3Jyh Eiin Wong^1,3Nik Shanita Safii^1,3Ilse Khouw⁴Bee Koon Poh^1,3*

• ¹Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
• ²School of Pharmacy, Monash University Malaysia, 47500, Subang Jaya, Malaysia
• ³Obesity-UKM Research Group, Universiti Kebangsaan Malaysia, 43600, Bangi, Malaysia
• ⁴FrieslandCampina,, Amersfoort, Netherlands

Introduction: Malnutrition and poor growth among children remain a public health challenge, largely driven by socioeconomic disparities that limit access to nutritious food. This study examines association of socioeconomic characteristics with food security, diet quality, and growth among Malaysian children. Methods: Cross-sectional data from South East Asian Nutrition Surveys (SEANUTS II) Malaysia, involving 2,973 children aged 0.5-12.9 years, were analysed. Socioeconomic characteristics, including information on children and households, were collected via questionnaires. Food insecurity was assessed using the 10-item Radimer/Cornell instrument. Dietary intake was assessed using a 24-hour recall, with diet quality determined by Mean Adequacy Ratio (MAR), derived from average Nutrient Adequacy Ratio for 15 nutrients based on Estimated Average Requirement (EAR). Growth outcomes were examined using body mass index-for-age (BAZ), height-for-age (HAZ), and weight-for-age (WAZ) z-scores. Complex samples ANOVA compared food security, diet quality, and growth indicators with socioeconomic characteristics. Results: Over half of the children (59.8%) were from low-income households. Although 47.8% had low food expenditure and 41.7% were food insecure, overall diet quality was reflected in MAR scores of 0.84 (maximum=1.00). Child hunger was more common in rural areas, in households with lower parental education, unemployed mothers, lower income, lower food expenditure, and more siblings (p<0.01). Younger, urban children, boys, Chinese or other ethnicities, from households with higher maternal education, and fewer siblings had better diet quality (p<0.05). Lower HAZ and WAZ were more common among younger children, Malays, households with non-working mothers, lower incomes, lower food expenditures, and more siblings (p<0.05). Children from rural areas had lower HAZ (p<0.01). Younger children, girls, lower household income, and lower food expenditure had lower BAZ (p<0.05). Conclusions: Socioeconomic disparities are significantly associated with compromised food security, poorer diet quality, and suboptimal growth among Malaysian children. Findings highlight the importance of addressing socioeconomic inequalities through targeted policies and evidence-based interventions ensuring equitable nutritional health and growth among vulnerable children.