Nutrient Intake Adequacy among Adults in Indonesia and Malaysia: A Systematic Review and Meta-Analysis

Under- or overconsumption of nutrients significantly increases the likelihood of future health impairments. However, comprehensive studies that systematically analyzed nutrient intake, especially among adults, are limited. This systematic review and meta-analysis explored studies reporting macro- and micronutrient intake among adults aged ≥18 y in Indonesia and Malaysia (PROSPERO: CRD42023464054). In total, 4501 studies were retrieved from 4 databases (PubMed, Scopus, ProQuest, and Cochrane) and searched manually from January 1980 to December 2023. Nutrient adequacy was determined by calculating the percentage of Recommended Daily Allowance (RDA)/Recommended Nutrient Intake (RNI), Estimated Average Recommendation (EAR), and Standardized Mean Differences (SMDs) for several nutrients. The systematic review of 82 studies revealed variations in energy and macronutrient intake among Indonesian and Malaysian adults. The meta-analysis showed that protein intake among Malaysians exceeded the recommendation [SMD: 0.56; 95% CI: 0.29, 0.684] but was insufficient among Indonesians (SMD: -0.86 (95% CI: -2.11, 0.39). Twenty-six studies reported insufficient fiber intake (10.7%-72.7% RDA/RNI) in both countries. Fat-soluble vitamin intake, except for vitamin A, was lower than 100% EAR. Meanwhile, a wide range of water-soluble vitamin intake was observed (13%-838% EAR). Calcium intake was reported as insufficient in 18 studies (N = 5394) (Overall SMD: -3.69; 95% CI: -4.18, -3.19; Indonesia SMD: -5.55; Malaysia SMD: -3.35). Magnesium intake was inadequate, although phosphorus and sodium intake were excessive in Malaysian adults. Moreover, there was inadequate intake (<100% EAR) of potassium, manganese, and copper among adults in both countries, and also iron and zinc in Indonesia. Selenium intake exceeded the recommendation (33-103 μg/158%-450% EAR) for Indonesians but not for Malaysian adults. In conclusion, Indonesian and Malaysian adults had a wide range of adequacy in energy and nutrient intake particularly for macronutrients and water-soluble vitamins. Some deficiencies in nutrients include fiber, fat-soluble vitamins, calcium, potassium, manganese, and copper persisted in both countries, Indonesians lacked iron and zinc intake, while Malaysians had low magnesium intake. In contrast, excessive sodium and phosphorus intake were observed in Malaysians, while Indonesians showed excessive selenium intake. Multistakeholder collaboration is essential to promote a healthy diet while maintaining regulations for individual dietary intake.