KUALA LUMPUR, Mar 2 — More than half of hospital patients and up to 70 per cent of cancer patients in Malaysia are at risk of disease-related malnutrition (DRM), according to studies cited by the Malaysian Dietitians’ Association (MDA).
In a 337-page report tabled in the Dewan Rakyat on February 23, MDA president Prof Dr Barakatun Nisak Mohd Yusof told the Health parliamentary special select committee (PSSC) during its proceedings on November 10, 2025, that DRM occurs when disease causes loss of appetite, metabolic disturbances, and ongoing muscle loss.
DRM occurs across all patient groups, especially cancer at 70 per cent, kidney disease at 30 per cent, as well as heart disease, chronic obstructive pulmonary disease (COPD), and obesity.
Among older persons, about 70 per cent are affected, particularly those with sarcopenia (age-related muscle loss) and anorexia of ageing (reduced appetite in older age).
The cited studies include a Malaysian analysis of hospitalised cancer patients at the National Cancer Institute in Putrajaya, which found a high prevalence of malnutrition, and a Singapore study at the National University Hospital linking malnutrition to higher hospital costs, longer stays, increased readmission risk, and higher three-year mortality.
“What concerns us is that patients with disease-related malnutrition have twice the risk of hospital readmission. This is the issue I want to highlight. When they are readmitted, treatment costs increase by 20 to 30 per cent,” Dr Barakatun Nisak said, according to the Hansard published in the committee’s report.
Dr Barakatun Nisak said disease-related malnutrition has no specific medication and can only be managed with medical nutrition therapy, including foods for special medical purposes (FSMP), which are specially formulated nutrition products for patients with specific diseases.
No Coverage For Medical Nutrition Therapy
The Health PSSC, chaired by Suhaizan Kaiat (PH-Pulai), noted in its report that subsidies for clinical nutrition formulas are currently limited to hospital settings, with post-discharge costs borne by patients, affecting continuity of care in the community.
Medical nutrition therapy is not covered under public financing schemes such as PeKa B40 or ProtectHealth. In the private sector, there is also no mandatory referral to dietitians due to the lack of coverage.
As a result, patients in both settings must pay out of pocket for prescribed “medical nutrition”, including specialised formulas costing RM12 to RM20 per day, posing a significant and cumulative financial burden on households.
Dr Barakatun Nisak noted that these products are part of structured treatment in hospitals, similar to medication, but are not subsidised once patients return home.
“When patients are discharged, continuity of care is lost at primary level. We cannot provide medical nutrition supplies, symptoms recur, and patients return to hospital, which we do not want. Meals on Wheels is appreciated, but not sufficient, as DRM patients require specific therapeutic meal plans,” she said.
In comparison, Indonesia’s BPJS (Social Security Agency for Health) health insurance covers medical nutrition therapy and oral nutrition formulas as part of treatment.
Shortage Of Dietitians Limits Access To Care
Dr Barakatun Nisak, a practising dietitian at the Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, said workforce constraints are further limiting access to clinical nutrition care, particularly in primary care settings.
“On workforce, like it or not, we must address this. Malaysia has more than 1,000 health clinics, but only 55 per cent have access to dietitians,” she said. About 120 dietitians are currently deployed, each covering five to 10 clinics, restricting the number of patients seen.
“On average, a dietitian can see only five to eight patients per day, about 100 patients per month. This is only 0.8 per cent of total patients. So the impact will not be visible.”
Most dietitians remain concentrated in hospitals, with less than 10 per cent placed in health clinics, where they provide counselling and therapeutic meal plans for patients with chronic conditions and high-risk pregnancies.
Dr Barakatun Nisak said dietitians play a different role from nutritionists, who focus on prevention. “Dietitians are at the end point, managing patients with disease or high risk, to reduce complications.”
Despite high needs among vulnerable groups, access remains limited. Among older persons at risk of malnutrition, only 0.07 per cent were managed in 2024.
Dr Barakatun Nisak also highlighted system constraints due to high patient load, which have shifted services away from individualised care.
“Ideally, dietitians provide group counselling or individual counselling. However, due to the high number of patients, we have to switch from counselling to general education, which is not personalised,” she said.
