In a ceremony steeped in pomp and centuries of tradition, the 47-year-old Sultan, dressed in gold-coloured traditional Malay formal wear, took the oath of office in the national palace in Kuala Lumpur.
The ceremony, marked by honour guards and Islamic prayers, was televised nationally and attended by Prime Minister Najib Razak and hundreds of guests decked out in Islamic finery.
Sultan Muhammad V, currently the ceremonial ruler of the conservative Islamic northern state of Kelantan, takes the national throne under the rotating monarchy in place since independence from Britain in 1957.
Sultan Muhammad V studied at St Cross College at Oxford and the Oxford Centre for Islamic Studies, according to official media.
He is known for a relaxed public persona, taking part in walkathons to promote health, and has been photographed wearing a baseball cap backwards.
The Sultan "fills his free time by reading and has an interest in extreme sports such as four-wheel drive expeditions and endurance challenges and shooting," Bernama news agency said.
Portraits of the king and queen adorn government buildings throughout the country. The king is also the symbolic head of Islam in the nation, as well as the nominal chief of the military.
Malaysia's sultans trace a lineage back to Malay sultanates of the 15th century. The king is referred to as Yang di-Pertuan Agong, or "He Who Is Made Lord".
Sultan Muhammad V replaces Sultan Abdul Halim Mu'adzam Shah from the northern state of Kedah, now 89, who was king previously in the 1970s and became the first person to hold the position twice.
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