Associations Between Nutritional Status and Mental Health Outcomes among Adolescents in Sarawak, Malaysia: Double Burden in Adolescents
Abstract
This study aimed to determine the prevalence of nutritional status and mental health problems among adolescents in the Samarahan District, Sarawak, and to explore their relationship. A cross-sectional study was conducted on 450 adolescents aged 10−19 years old. Nutritional status was assessed using Body Mass Index (BMI)-for-age and height-for-age z-scores, and mental health was evaluated using the Strengths and Difficulties Questionnaire (SDQ). The SDQ was validated and translated into the Malay language. The internal consistency was 0.71, and the item-total correlation exceeded 0.3. Spearman’s correlation was used to analyse relationships between variables. The study revealed that 25.1% of the adolescents were overweight or obese, while 9.4% were underweight. Stunting affected 12% of the participants. The mental health assessment revealed that 26.7% of adolescents fell within the abnormal range. The SDQ score was categorised into normal (0−15), borderline (16−19), and abnormal (20−40). Weak but significant correlations were found between BMI-for-age z-scores and conduct problems status (r=-0.105, p<0.05) and between gender and emotional conduct problems (r=0.158, p<0.001). This study highlights the coexistence of malnutrition and mental health issues among adolescents in Sarawak. Integrated interventions addressing both nutritional and mental health needs are recommended, with a particular focus on gender-specific approaches and peer relationship support.
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References
Ahmad N, MuhdYusoff F, Ratnasingam S, Mohamed F, Nasir NH, MohdSallehuddin S, MahadirNaidu B, Ismail R, Aris T. 2015. Trends and factors associated with mental health problems among children and adolescents in Malaysia. Int J Cult Ment Health 8(2):125−136. https://doi.org/10.1080/17542863.2014.907326
Bera L, Souchon M, Ladsous A, Colin V, López-Castromán J. 2022. Emotional and behavioral impact of the COVID-19 epidemic in adolescents. Curr Psychiatry Rep 24(1):37−46. https://doi.org/10.1007/s11920-022-01313-8
Chávez DV, Palacios D, Laninga-Wijnen L, Salmivalli C, Garandeau CF, Berger C, Luengo Kanacri BP. 2025. Do adolescents adopt the prosocial behaviors of the classmates they like? A social network analysis on prosocial contagion. J Youth Adolesc 54:17−31. https://doi.org/10.1007/s10964-024-02037-z
Department of Statistics Malaysia. 2024. Population table: Administrative districts. https://open.dosm.gov.my/data-catalogue/population_district?state=sarawak&district=samarahan&visual=table [Accessed 14th November 2025]
Erskine HE, Baxter AJ, Patton GC, Moffitt TE, Patel V, Whiteford HA, Scott JG. 2016. The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiol. Psychiatr Sci 26:395−402. https://doi.org/10.1017/s2045796015001158
Estecha Querol S, Iqbal R, Kudrna L, Al-Khudairy L, Gill P. 2021. The double burden of malnutrition and associated factors among South Asian adolescents: Findings from the global school-based student health survey. Nutr 13(8):2867. https://doi.org/10.3390/nu13082867
Gonzalez-Fernandez D, Cousens S, Rizvi A, Chauhadry I, Soofi SB, Bhutta ZA. 2023. Infections and nutrient deficiencies during infancy predict impaired growth at 5 years: Findings from the MAL-ED study in Pakistan. Front Nutr 10:1104654. https://doi.org/10.3389/fnut.2023.1104654
Hassan NM, Husain R, Aziz AbA, Mazubir NN, Juhari SN, Daud N. 2019. Validation of the Malay version of the Self-rated Strength and Difficulties (SDQ) questionnaire. The International Journal of Academic Research in Business and Social Sciences 9(11):358−373. http://dx.doi.org/10.6007/IJARBSS/v9-i11/6553
Ishak NA, Mohd Satar N, Zakaria R. 2020. Parental involvement in education among urban families in Malaysia. J Southeast Asian Stud 25(2):60−85. https://doi.org/10.22452/jati.vol25no2.4
Jafar N, Syam A, Kurniati Y, Kurnaesih E, Ahri RA, NJ. 2020. Association of gender, triglyceride/hdl ratio, and physical activity of obese adolescents in Makassar. Open Access Maced J Med Sci 25(8):81−86. https://doi.org/10.3889/oamjms.2020.5229
Kirolos A, Goyheneix M, Kalmus Eliasz M, Chisala M, Lissauer S, Gladstone M, Kerac M. 2022. Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: A systematic review. BMJ Glob Health 7(7):e009330. https://doi.org/10.1136/bmjgh-2022-009330
Krishnan V, Zaki RA, Nahar AM, Jalaludin MY, Majid HA. 2021. The longitudinal relationship between nutritional status and anaemia among Malaysian adolescents. Lancet Reg Health West Pac 15:100228. https://doi.org/10.1016/j.lanwpc.2021.100228
Kumar S, Singh R, Singh AK. 2018. To study the risk factors associated with overweight and obesity among adolescents in Patna, Bihar. Int J Contemp Med Res 5(9):11−13. https://doi.org/10.21276/ijcmr.2018.5.9.6
Lai WK, Palaniveloo L, Mohd Sallehuddin S, Ganapathy SS. 2024. Double burden of malnutrition and its socio-demographic determinants among children and adolescents in Malaysia: National Health And Morbidity Survey 2019. J Health Popul Nutr 43(1):94. https://doi.org/10.1186/s41043-024-00583-7
Lee WS, Jalaludin MY, Khoh KM, Kok JL, Nadarajaw T, Soosai AP, Mukhtar F, Fadzil YJ, Anuar Zaini A, Mohd-Taib SH et al. 2022. Prevalence of undernutrition and associated factors in young children in Malaysia: A nationwide survey. Front Pediatr 10:913850. https://doi.org/10.3389/fped.2022.913850
Long E, Zucca C, Sweeting H. 2020. School climate, peer relationships, and adolescent mental health: A social ecological perspective. Youth Soc 53(8):1400−1415. https://doi.org/10.1177/0044118x20970232
Marinković B, Ćorluka B, Vukajlović M, Bjelica B, Aksović N, Bubanj S, Petković, E, Preljević A, Lilić L, Dobrescu T, et al. 2024. The relationship between psychological factors and nutritional status in adolescence. Children 11(11):1365. https://doi.org/10.3390/children11111365
Mühlig Y, Antel J, Föcker M, Hebebrand J. 2016. Are bidirectional associations of obesity and depression already apparent in childhood and adolescence as based on high‐quality studies? A systematic review. Obes Rev 17(3):235−249. https://doi.org/10.1111/obr.12357
[NIH] National Institutes of Health. 2020. National Health and Morbidity Survey (NHMS) 2019: Technical Report−Vol. I: NCDs – Non-Communicable Diseases: Risk Factors and other Health Problems. SGR (KL): Institute of Public Health Malaysia, National Institutes of Health (NIH), Ministry of Health, Malaysia.
[NIH] National Institutes of Health. 2022. Technical Report National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey, Malaysia. SGR (KL): Institute of Public Health Malaysia, National Institutes of Health (NIH), Ministry of Health, Malaysia.
Nauli SNN, Bardosono S, Wiradnyani LAA. 2021. Nutritional status indicator and its correlation with mental health score among adolescents in Islamic Boarding Schools. World Nutr J 5(1):95−105. https://doi.org/10.25220/wnj.v05.i1.0013
Nearchou F, Flinn C, Niland R, Subramaniam SS, Hennessy E. 2020. Exploring the impact of COVID-19 on mental health outcomes in children and adolescents: A systematic review. Int J Environ Res Public Health 17(22):8479. https://doi.org/10.3390/ijerph17228479
O’Neil A, Quirk SE, Housden S, Brennan SL, Williams LJ, Pasco JA, Berk M, Jacka FN. 2014. Relationship between diet and mental health in children and adolescents: A systematic review. Am J Public Health 104(10):e31−42. https://doi.org/10.2105/ajph.2014.302110
Onis MD, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. 2007. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85(9):660−667. https://doi.org/10.2471/blt.07.043497
Partap U, Young EH, Allotey P, Sandhu MS, Reidpath DD. 2019. Characterisation and correlates of stunting among Malaysian children and adolescents aged 6−19 years. Glob Health Epidemiol Genom 4:e2. https://doi.org/10.1017/gheg.2019.1
Pauzi HM, Sahide NM. 2023. The development of adolescent mental health services in Malaysia: A review. Int J Acad Res Bus Soc Sci 2840−2851. https://doi.org/10.6007/IJARBSS/v13-i12/19395
Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, Prentice A. 2013. Critical windows for nutritional interventions against stunting. Am J Clin Nutr 97(5):911−918. https://doi.org/10.3945/ajcn.112.052332
Sahril N, Adnan MAA, Khalil MKN, Chan YM, Yoga Ratnam KK, Lai WK, Ahmad NA. 2023. Association of dietary behaviour and depression among adolescents in Malaysia: A cross-sectional study. J Health Popul Nutr 42(1):133. https://doi.org/10.1186/s41043-023-00480-5
Singh S, Zaki RA, Farid NDN, Kaur K. 2022. The determinants of mental health literacy among young adolescents in Malaysia. Int J Environ Res Public Health 19(6):3242. https://doi.org/10.3390/ijerph19063242
Van Vuuren CL, Wachter GG, Veenstra R, Rijnhart JJ, Van der Wal MF, Chinapaw MJ, Busch V. 2019. Associations between overweight and mental health problems among adolescents, and the mediating role of victimisation. BMC Public Health 19(1):612. https://doi.org/10.1186/s12889-019-6832-z
[WHO] World Health Organization. 2023. BMI-for-age (5−19 years). https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age [Accessed 14th November 2025]
Wang S, Sun Q, Zhai L, Bai Y, Wei W, Jia L. 2019. The prevalence of depression and anxiety symptoms among overweight/obese and non-overweight/non-obese children/adolescents in China: A systematic review and meta-analysis. Int J Environ Res Public Health 16(3):340. https://doi.org/10.3390/ijerph16030340
Wong HS, Tay JEF, Kaur S, Gan WY, Che’Ya NN, Tan CH, Tung SEH. 2024. Knowledge and practices in preventing nutritional anaemia of the urban poor adolescents in Kuala Lumpur, Malaysia. Nutr Health 30(2):331−340. https://doi.org/10.1177/02601060221122182
Yee SH. 2023. A Study on the relationship between parents’ educational leveland their involvement in children’s learning In Johor. Johor (KL): Universiti Tunku Abdul Rahman, Kuala Lumpur. http://web.usm.my/km/29%282%292011/Art3_KM29-2.pdf
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