Prevalence of overweight/obesity and its associated factors among secondary school students in semi urban area in Malaysia

INTRODUCTION

This cross-sectional study aimed to determine the prevalence of overweight and obesity and factors associated among secondary school students in Batang Padang District, Perak, Malaysia.

METHODS

Out of the 7247 students in the ten selected schools studied, a total of 6248 students (2928 males, 3320 females) took part. A validated self-administered questionnaire was used. Data was analysed using SPSS version 22. Multivariable logistic regression was used to determine the adjusted odd ratio.

RESULTS

The prevalence of overweight and obesity was 16.0% and 11.5% respectively. Obesity/overweight was significantly (p<0.05) associated with gender, age, ethnicity, education level of father, education level of mother, physical activity, disordered eating, smoking status, body size perception and body part satisfaction. The multivariable analysis results showed that the odds of being overweight/obesity were higher in males compared to females (OR 1.56, 95%CI: 1.37, 1.77). The results also showed that the odds of being overweight/obesity were highest among those in age group 12 and 13 years and among Malay ethnicity. The odds of overweight/obesity were higher in those who was dissatisfied with their body parts, (OR 1.96, 95%CI: 1.71, 2.25), dissatisfied with their body size (OR: 4.25, 95%CI: 3.60, 5.02), low physical activity (OR 1.23, 95%CI: 1.06, 1.44), current smokers (OR 1.38, 95%CI: 1.07, 1.78) and at risk of having eating disorder (OR: 1.39, 95%CI 1.22, 1.59).

CONCLUSION

The overall prevalence of overweight and obesity is high. The findings from this study can be used by policy makers to plan an integrated intervention program in schools.

Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia

BACKGROUND

Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors.

METHODS

This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3-59 months and non-pregnant mothers aged 15-55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households.

RESULTS

About 26 % of overweight and obese adults coexisting with high proportions of underweight (49%) and stunted (64%) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/UWSTC (20%) and OWOBM/STC (19.4%) than households with OWOBM/UWC (12.5%). Boys (P < 0.05), older age mothers (P < 0.05), mothers with higher education (P < 0.05) and households with income per capita less than USD 29.01 (RM 97.00) (P < 0.01) were associated with higher odds of OWOBM/STC. Jah Hut (P < 0.05) and higher number of children (P < 0.05) were significantly associated with lower odds of OWOBM/UWC.

CONCLUSIONS

The occurrence of double-burden of malnutrition in Orang Asli population deserves attention. Poverty reduction, access to quality diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population.

Nutritional outcomes related to household food insecurity among mothers in rural Malaysia

During the past two decades, the rates of food insecurity and obesity have risen. Although a relationship between these two seemingly-paradoxical states has not been repeatedly seen in men, research suggests that a correlation between them exists in women. This study examines nutritional outcomes of household food insecurity among mothers in rural Malaysia. A cross-sectional survey of low-income households was conducted, and 223 households with mothers aged 18-55 years, who were non-lactating, non-pregnant, and had at least one child aged 2-12 years, were purposively selected. A questionnaire was administered that included the Radimer/Cornell Scale, items about sociodemographic characteristics, and anthropometric measurements. Of the households, 16.1% were food-secure whereas 83.9% experienced some kind of food insecurity: 29.6% of households were food-insecure, 19.3% contained individuals who were food-insecure, and 35.0% fell into the 'child hunger' category. The result reported that household-size, total monthly income, income per capita, and food expenditure were significant risk factors of household food insecurity. Although there was a high prevalence of overweight and obese mothers (52%) and 47.1% had at-risk waist-circumference (> or = 80 cm), no significant association was found between food insecurity, body mass index, and waist-circumference. In conclusion, the rates of household food insecurity and overweight and obesity were high in the study population, although they are looking paradoxical. Longitudinal studies with larger sample-sizes are recommended to further examine the relationship between food insecurity and obesity.

Comparison of maternal characteristics in low birth weight and normal birth weight infants

Low birth weight is a key determinant in the risk of morbidity and mortality in the neonatal period and during childhood. This unmatched case-control study in Hamadan, Islamic Republic of Iran, compared the characteristics of mothers of low- and normal-birth-weight infants. Maternal sociodemographic data, pregnancy history, anthropometric data and cord plasma zinc level were collected from 134 mothers of low-birth-weight infants and 134 mothers of normal infants at the time of delivery. Significant differences in maternal characteristics namely gravida, parity, body mass index, maternal weight gain during pregnancy and plasma cord blood zinc were found between low- and normal-birth-weight infants. There were no significant differences in maternal age, maternal education, maternal occupation, family income, previous abortion, previous preterm labour, birth Iinterval, type of clinic and place of residence between the 2 groups.

The coexistence of dual form of malnutrition in a sample of rural malaysia

BACKGROUND

The coexistence of under and over nutrition might be influenced by a marked shift in dietary and lifestyle practices of people in developing countries. This study aims to identify factors associated with the occurrence of dual form of malnutrition in the same households in a rural district in Peninsular Malaysia.

METHODS

A cross sectional study was conducted on a 223 mother-child pairs based on several inclusion criteria such as; non-pregnant, non lactating mothers and having youngest children aged from 2 to 12 years old. Anthropometric indices of Weight-for-age Z score (WAZ) ≤ 1SD was used to classify underweight status in children and body mass index (BMI) ≥25kg/m(2) was used to measure overweight status among mothers. A pre-tested questionnaire was used to collect socio-demographic data, whereas food frequency questionnaire was used to assess the diet diversity.

RESULTS

The results showed that the prevalence of overweight mother/underweight child (OWM/UWC) pairs was 29.6%, whereas the prevalence of normal weight mother/normal weight child (NWM/NWC) pairs was 15.2%. Out of mother-child pairs measured, 61.0% of the children were underweight and 61.4% were stunted, whereas the prevalence of overweight and obesity in women were 35.0% and 17.0%, respectively. The study did not report any association between the dual burden of malnutrition and household size, number of children, educational level of the mother, total income, income per capita, and food expenditure, except with household type (OR:5.01;95% CI:1.63,15.34; P = 0.005). In general, the total diet diversity score of both types of mother-child pairs was low.

CONCLUSIONS

Dual forms of malnutrition in the same household exists in Malaysian households. This phenomenon will be a big challenge especially for food intervention programs to be implemented in the future.

Colorectal cancer and its association with the metabolic syndrome: a Malaysian multi-centric case-control study

OBJECTIVE

Colorectal cancer (CRC) and the metabolic syndrome (MetS) are both on the rise in Malaysia. A multi-centric case-control study was conducted from December 2009 to January 2011 to determine any relationship between the two.

METHODS

Patients with confirmed CRC based on colonoscopy findings and cancer free controls from five local hospitals were assessed for MetS according to the International Diabetes Federation (IDF) definition. Each index case was matched for age, gender and ethnicity with two controls (140: 280).

RESULTS

MetS among cases was highly prevalent (70.7%), especially among women (68.7%). MetS as an entity increased CRC risk by almost three fold independently (OR=2.61, 95%CI=1.53-4.47). In men MetS increased the risk of CRC by two fold (OR=2.01, 95%CI, 1.43-4.56), demonstrating an increasing trend in risk with the number of Mets components observed.

CONCLUSION

This study provides evidence for a positive association between the metabolic syndrome and colorectal cancer. A prospective study on the Malaysian population is a high priority to confirm these findings.

A workplace email-linked website intervention for modifying cancer-related dietary and lifestyle risk factors: rationale, design and baseline findings

INTRODUCTION

The use of email and website as channels for workplace health information delivery is not fully explored. This study aims to describe the rationale, design, and baseline findings of an email-linked website intervention to improve modifiable cancer risk factors.

METHODS

Employees of a Malaysian public university were recruited by systematic random sampling and randomised into an intervention (n = 174) or control group (n = 165). A website was developed for the intervention and educational modules were uploaded onto the website. The intervention group received ten consecutive weekly emails with hypertext links to the website for downloading the modules and two individual phone calls as motivational support whilst the control group received none. Diet, lifestyle, anthropometric measurements, psychosocial factors and stages of change related to dietary fat, fruit and vegetable intake, and physical activity were assessed.

RESULTS

Participants were predominantly female and in non-academic positions. Obesity was prevalent in 15% and 37% were at risk of co-morbidities. Mean intake of fats was 31%, fruit was -1 serving/day and vegetable was < 1 serving/day. Less than 20% smoked and drank alcohol and about 40% were physically inactive. The majority of the participants fell into the Preparation stage for decreasing fat intake, eating more fruit and vegetables, and increasing physical activity. Self-efficacy and perceived benefits were lowest among participants in the Precontemplation/Contemplation stage compared to the Preparation and Action/Maintenance stages.

CONCLUSION

Baseline data show that dietary and lifestyle practices among the employees did not meet the international guidelines for cancer prevention. Hence the findings warrant the intervention planned.

Relationship between family meals away from home and nutritional status of adolescents

INTRODUCTION

Despite the many benefits of family meals, data on association between family meals away from home (FMAFH) and nutritional status of adolescents is limited. This study determined the association between FMAFH with dietary intake and body mass index of adolescents (N = 408).

METHODS

Data were obtained through interviewer-administered questionnaire and anthropometric measurements of adolescents.

RESULTS

Respondents comprised 53.7% females, 67.6% Chinese with the mean age of sample being 13.7 +/- 0.6 years old. Generally, male adolescents had higher intakes of energy, macronutrients and micronutrients. All nutrients except calcium (51.3%), iron (females--54.7%) and vitamin A (females--86.1%) met the recommended intakes. A higher proportion of male (25.4%) than female (13.6%) adolescents were overweight and obese. About 44% of respondents had family meals > or = 7 times in the previous week with 48.9% reported having family meals at home > or = 7 times weekly. The majority (91.2%) of adolescents had FMAFH at least once a week either at restaurants (53%), fast food outlets (41.6%), food courts in shopping complexes (40%) or food stalls (30.2%). As the frequency of FMAFH increased, there was an increasing trend in energy and energy-adjusted nutrient intakes. However, only energy-adjusted fat intake was significantly high (p < 0.05) in adolescents having FMAFH > 7 times weekly. No significant association was observed for frequency of FMAFH and body mass index.

CONCLUSION

With increasing dependence on foods outside the home, FMAFH can be a source of healthy diet for families provided they have the knowledge, skills and motivation to make healthy food choices.

Validity and reliability of the Multidimensional Body Image Scale in Malaysian university students

INTRODUCTION

This study aimed to evaluate the validity and reliability of the Multidimensional Body Image Scale (MBIS), a seven-factor, 62-item scale developed for Malaysian female adolescents. This scale was evaluated among male and female Malaysian university students.

METHODS

A total of 671 university students (52.2% women and 47.8% men) completed a self-administered questionnaire on MBIS, Eating Attitude Test-26, and Rosenberg Self-Esteem Scale. Their height and weight were measured.

RESULTS

Results in confirmatory factor analysis showed that the 62-item MBIS reported poor fit to the data, xhi2/df = 4.126, p < 0.001, CFI = 0.808, SRMR = 0.070, RMSEA = 0.068 (90% CI = 0.067, 0.070). After re-specification of the model, the model fit was improved with 46 items remaining, chi2/df = 3.346, p < 0.001, CFI = 0.903, SRMR = 0.053, RMSEA = 0.059 (90% CI = 0.057, 0.061), and the model showed good fit to the data for men and women separately. This 46-item MBIS had good internal consistency in both men (Cronbach's alpha = 0.88) and women (Cronbach's alpha = 0.92). In terms of construct validity, it showed positive correlations with disordered eating and body weight status, but negative correlation with self-esteem. Also, this scale discriminated well between participants with and without disordered eating.

CONCLUSION

The MBIS-46 demonstrated good reliability and validity for the evaluation of body image among university students. Further studies need to be conducted to confirm the validation results of the 46-item MBIS.

Meal patterns of malaysian adults: findings from the Malaysian adults nutrition survey (MANS)

INTRODUCTION

Meal patterns have received little attention in nutrition studies. The aim of this study is to present the findings on general meal patterns of Malaysian adults.

METHODS

The Malaysian Adults Nutrition Survey (MANS), carried out in 2002 and 2003, involved 6,928 adults selected by stratified random sampling from all households by zone in Peninsular Malaysia, Sabah and Sarawak.

RESULTS

In general, the results showed that most respondents (74.16%) ate three meals per day; 89.20% of the respondents consumed breakfast, while 88.57% consumed lunch and 91.97% consumed dinner with no significant difference in terms of sex. In Peninsular Malaysia, the Northern Zone had the highest number of people consuming breakfast compared to other zones. Meanwhile, the population in Sarawak had the largest proportion of people consuming lunch and dinner, but the smallest proportion of people consuming breakfast. A significantly higher number of the rural population consumed breakfast and lunch than urbanites; however there was no significant difference in dinner consumption. Generally, breakfast consumption increased with age whereby significant difference existed between the 18 to 19 years age group and the age group of 30 years and older. Lunch intake among the age groups showed no significant difference. In contrast, dinner consumption was significantly lower among the 18 to 19 years age group compared to all other age groups. Comparison among the ethnic groups showed that the Indian population had the lowest percentage of having breakfast and lunch while the Orang Asli had the lowest percentage of consuming dinner. However, the Orang Asli recorded the highest percentage for taking breakfast and lunch while the Chinese had the highest percentage of taking dinner.

CONCLUSION

Considering that Malaysian adults consumed their conventional breakfast, lunch and dinner, these findings indicatethat Malaysians are maintaining their traditional meal patterns.

Dietary diversity is associated with nutritional status of Orang Asli children in Krau Wildlife Reserve, Pahang

INTRODUCTION

It is known that dietary diversity improves diet quality and nutritional status of young children. This study aimed to determine the relationship between dietary diversity and nutritional status of Orang Asli children in Krau Wildlife Reserve.

METHODS

A total of 216 children from three Orang Asli sub-tribes (Jah Hut, Temuan and Che Wong) aged 1 to 6 years from 162 households in 16 villages participated in this cross-sectional study. Children and mothers were measured for body weight and height. Mothers were interviewed for household socio-demographic information and diet diversity of children in the last 7 days. Diet diversity score (DDS) was calculated based on 15 food groups.

RESULTS

There was a high prevalence of underweight (50.9%) and stunting (61.6%) in Orang Asli children. For mothers, 11.1%, 27.8% and 7.4% were underweight, overweight and obese, respectively. Mean DDS of children was 6.38 [95% CI-6.10, 6.65] of the possible 15. Higher DDS of children was significantly related to older age (p < 0.05), the non Jahut sub-tribe (p < 0.01) and longer maternal years of schooling (p < 0.05). DDS was also positively related to weight-for-age z-scores (p < 0.001) and height-for-age z-scores (p < 0.05).

CONCLUSION

Undernutrition remains a major nutrition problem among Orang Asli children living within the forest reserve. Efforts to promote dietary diversity should emphasise traditional and nutritious foods that could improve health and nutritional status of the Orang Asli children.

Determination of factors associated with physical activity levels among adolescents attending school in Kuantan, Malaysia

INTRODUCTION

Findings from the National Health and Morbidity Survey III (MOH, 2008) indicate a 43.7% prevalence of physical inactivity among Malaysian adults. This sedentary lifestyle can also be observed among children and adolescents.

METHODOLOGY

A cross-sectional study was conducted to determine factors associated with physical activity levels of four hundred, 13 year-old adolescents in Kuantan, Pahang. Data on socio-demographic, health-related, and psychosocial factors were collected using a self-administered questionnaire while physical activity level was assessed using the Physical Activity Questionnaire for Older Children (PAQ-C).

RESULTS

About one-third of the respondents were in the low physical activity level category, 61.5% were in the moderate category and only 3.0% of the adolescents were in the high physical activity level category. Males were more physically active than females (chi2 = 23.667, p = 0.0001) with female adolescents (45.1%) twice as likely as male adolescents (22.1%) to be in the low physical activity level category. The associations between physical activity level with socio-demographic and health-related factors, perception of weight status and body parts satisfaction were not significant. However, physical activity was found to be positively correlated with physical activity self-efficacy (r = 0.496, p = 0.0001), peer influence ( r = 0.468, p = 0.0001), family influence (r = 0.298, p = 0.0001) and beliefs in physical activity outcomes (r = 0.207, p = 0.0001). Negative relationships were found between physical activity with depression (r = -0.116, p = 0.021) and body size discrepancy (r = -0.143, p < 0.01). Respoedbnts who had a better perception of their current health status were more physically active chi2 = 21.062, p = 0.0001). Multivariate analyses for the prediction of physical activity showed that physical activity self-efficacy, sex and peer influence were the most significant contributors in explaining physical activity among adolescents.

CONCLUSION

Physical activity interventions should include psychosocial components as mediator variables in interventions designed to promote regular physical activity in adolescence.

Differences in eating behaviours, dietary intake and body weight status between male and female Malaysian University students

INTRODUCTION

University students are potentially important targets for the promotion of healthy lifestyles as this may reduce the risks of lifestyle-related disorders later in life. This cross-sectional study examined differences in eating behaviours, dietary intake, weight status, and body composition between male and female university students.

METHODOLOGY

A total of 584 students (59.4% females and 40.6% males) aged 20.6 +/- 1.4 years from four Malaysian universities in the Klang Valley participated in this study. Participants completed the Eating Behaviours Questionnaire and two-day 24-hour dietary recall. Body weight, height, waist circumference and percentage of body fat were measured.

RESULTS

About 14.3% of males and 22.4% of females were underweight, while 14.0% of males and 12.3% of females were overweight and obese. A majority of the participants (73.8% males and 74.6% females) skipped at least one meal daily in the past seven days. Breakfast was the most frequently skipped meal. Both males and females frequently snacked during morning tea time. Fruits and biscuits were the most frequently consumed snack items. More than half of the participants did not meet the Malaysian Recommended Nutrient Intake (RNI) for energy, vitamin C, thiamine, riboflavin, niacin, iron (females only), and calcium. Significantly more males than females achieved the RNI levels for energy, protein and iron intakes.

CONCLUSION

This study highlights the presence of unhealthy eating behaviours, inadequate nutrient intake, and a high prevalence of underweight among university students. Energy and nutrient intakes differed between the sexes. Therefore, promoting healthy eating among young adults is crucial to achieve a healthy nutritional status.

Physical Activity Pattern and Energy Expenditure of Malaysian Adults: Findings from the Malaysian Adult Nutrition Survey (MANS)

This paper aims to report the physical activity pattern and energy expenditure of adults aged 18 - 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. The survey included 7349 adults representative of Peninsular Malaysia (Northern, Southern, Central and East Coast), as well as Sabah and Sarawak. A total of 6926 adults, comprising 3343 men and 3583 women, completed the physical activity section of the survey. Physical activity data was obtained using a physical activity questionnaire and 24-hour physical activity recall. Basal metabolic rate (BMR) was calculated from Ismail et al. (1998) predictive equations; total energy expenditure (TEE) was then estimated through factorial calculations based on time allocated and energy cost of various activities. Physical activity level (PAL) was calculated as the ratio of TEE to BMR. It was found that almost three-quarters of Malaysian adults traveled by passive modes of transportation. Only a third reported having ever-exercised, and an even smaller proportion of the population (14%) had adequate exercise. The population also spent the majority of their time (74% of the day) in sedentary activities, such as sleeping or lying down; doing light intensity activities (15% of the day), and doing moderate to vigorous intensity activities (10% of the day). Mean BMR and TEE was significantly higher amongst men than women, while mean PAL values were similar for men [1.6 (1.6 - 1.7)] and women [1.6 (1.6 - 1.6)]. More men (16%) were categorised as having active PAL compared to women (10%), while more women (43%) were categorised as having sedentary PAL compared to their male counterparts (37%). The present study provides the first in-depth report of the physical activity pattern, and national estimates of energy expenditure and physical activity levels of Malaysian adults, and concluded that Malaysian adults are generally sedentary. It is thus important that physical activity be further promoted and integrated into the lives of the population, preferably through various health promotion efforts as well as through the commitment of the authorities in providing a suitable environment for an active lifestyle.

Nutritional status of orang asli (che wong tribe) adults in krau wildlife reserve, pahang

This is a descriptive study on nutritional status of Orang Asli (Che Wong tribe) adults in Krau Wildlife Reserve. Twenty-six households, comprising 29 men and 28 women,participated in the study. Dietary diversity was assessed using food frequency questionnaire with 37 food groups. Weight, height and waist circumference were measured using standard instruments. The mean age for men and women was 39.9 ± 17.1 years and 33.7 ± 16.1 years, respectively. Most (89.5%) of the adults had no formal education and about 89.5% of households were categorised as poor. There were 13.8% underweight, 72.4% normal, 10.3% overweight and 3.3% obese men. For women, 25.0%, 46.4%, and 28.6% were underweight, normal and overweight, respectively. While none of the men had at-risk waist circumference (men >90 cm), about 21.4% of women had waist circumference of >80 cm. The mean dietary diversity score was 9.47 ± 4.15 with men (9.48 ± 3.70) and women (9.46 ± 4.63) having similar scores. There was a significant correlation between waist circumference and household income (r=0.36, p< 0.01); however, the association was only significant in women (r=0.50, p< 0.01). Although under-nutrition still prevails, there are emerging cases of overweight and obesity in this rural Orang Asli community undergoing nutrition transition especially among the females.

A Qualitative Study on Coping Strategies among Women from Food Insecurity Households in Selangor and Negeri Sembilan

Understanding the experiences of household food insecurity is essential for better measurement and assessment of its nutritional, physical and psychological consequences. This qualitative study explored coping strategies and their perceived severity in relation to household food insecurity. Women (n=57; 20-50 years old) from rural and urban areas in Selangor and Negeri Sembilan participated in this study. These women were interviewed using a semi-structured questionnaire. The questionnaire was divided into two parts, that is, demographic and socio-economic information and women's experiences of coping with household food insecurity. Women were chosen since they were primarily responsible for food acquisition and preparation for the all household members. Thematic analysis was utilized in data analysis. Thematic analysis is a method for identifying, analysing and reporting patterns and themes of the qualitative data. Themes capture something important related to the study objectives and describe an integrating as well as relational idea from the data. Results showed that households displayed a variety of non-food related coping strategies and food-related coping strategies. Women's descriptions of non-food related coping strategies to food insecurity were categorised into five themes i.e. cloth purchasing behaviors, reduce school-going children's expenditure, delay the payment of bills, adjust lifestyle and increase cash and income earning. Food related coping strategies were categorised into four themes i.e. food stretching, food rationing, food seeking and food anxiety. Food stretching is a strategy of food insecurity that affects the quality of diet. Food rationing comprises coping strategies of food insecurity related to the quantity of food available for household's consumption. Food seeking is a strategy of acquiring food through socially unacceptable ways and food anxiety is a strategy that indicates households allocating money to buy staple food in order to prevent food insecurity. Each coping strategy showed a different level of perceived severity, that is, less severe, quite severe, severe and very severe. In conclusion, the qualitative data provide valuable information for understanding the experiences of food insecurity that can be used as a basis to develop direct indicators that can capture the core behaviours and their level of severity to measure household food insecurity.

Body Mass Index (BMI) of Adults: Findings of the Malaysian Adult Nutrition Survey (MANS)

The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 - 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI > 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI > 25 - 29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40 - 49 years. Obesity was highest for those whose household income was between RM1,500 - 3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urban rural differential in both obesity and overweight. The study found 9.02% (CI:8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country's resources and development.

Relation of dietary fat intake perception to nutritional status and psychosocial factors

Excess dietary fat intake is associated with many chronic diseases. This cross-sectional study determines the differences in nutritional status and diet-related psychosocial factors by accuracy levels of dietary fat intake perceptions among adults. A total of 202 Universiti Putra Malaysia staff (20-55 years old) volunteered to participate in the study. Dietary fat accuracy levels (under-estimate, accurate and over-estimate) were determined by assessing actual fat intake through 24-hour diet recall and self-rated fat intake. Diet-related psychosocial factors assessed were perceived risks, intention to change, outcome expectancies and perceived barriers. About half (49.5%) of the respondents were classified as accurate estimators, while 35.6% and 14.9% were under-estimators and over-estimators, respectively. Dietary fat intake differed significantly between the dietary fat accuracy groups with under-estimators having the highest amount of dietary fat intake (F=17.10; p<0.001) and percentage of fat calories (F=103.99 + 0.533%, p<0.001). Over-estimators had the highest mean BMI (F=3.11, p<0.05) compared to other groups. Among the fat accuracy groups, under-estimators reported the least barriers to eating low fat foods (F= 3.671, p<0.05). There were no significant differences in waist circumference, energy intake, perceived disease risks, intention to change and outcome expectancies among the dietary fat accuracy groups. These findings suggest that inaccurate perceptions of dietary fat intake should not be overlooked as one of the cognitive barriers to dietary change and factors that influence nutritional status among adults.

Perceptions of body image among Malaysian male and female adolescents

INTRODUCTION

Body image concerns are common among adolescents as they undergo rapid physical growth and body shape changes. Having a distorted body image is a risk factor for the development of disordered eating behaviours and eating disorders. This study was undertaken to investigate body image concerns among Malaysian male and female adolescents aged 11-15 years.

METHODS

A total of 2,050 adolescents (1,043 males and 1,007 females) with a mean age of 13.1 +/- 0.8 years from secondary schools in Kedah and Pulau Pinang were included in the study. Questionnaires were used to collect socioeconomic data and body image indicators.

RESULTS

The majority (87 percent) of the adolescents were concerned with their body shape. While the majority of underweight, normal weight and overweight male and female subjects perceived their body weight status correctly according to their body mass index (BMI), a noteworthy proportion in each category misjudged their body weight. About 35.4 percent of the males and 20.5 percent of the females in the underweight category perceived themselves as having a normal weight, while 29.4 percent and 26.7 percent of the overweight males and females respectively also perceived that they had a normal weight. A higher proportion of the females (20 percent) than males (9 percent) with a normal BMI perceived themselves as fat. Most of the male (78-83 percent) and female subjects (69-74 percent) in all the BMI categories desired to be taller than their current height. An appreciable proportion of both the males (41.9 percent) and females (38.2 percent) preferred to remain thin, or even to be thinner (23.7 percent of males and 5.9 percent of females). Females had a significantly higher mean body dissatisfaction score than males, indicating their preference for a slimmer body shape. More males (49.1 percent) preferred a larger body size while more females (58.3 percent) idealised a smaller body size. Compared to normal weight and underweight subjects, overweight males and females expressed lower confidence and acceptance levels, as well as expressed greater preoccupation with and anxiety over their body weight and shape.

CONCLUSION

As having a distorted body image may lead to negative effects such as unhealthy eating habits and disordered eating behaviours, it is recommended that appropriate educational efforts on body image be incorporated into school health activities for adolescents.

Daily Energy Intake from Meals and Afternoon Snacks: Findings from the Malaysian Adults Nutrition Survey (MANS)

Meal and snack patterns are associated with energy and nutrient intakes and consequently health and nutritional status. The aim of this paper is to describe the percentage of daily energy intake from meals and afternoon snack among Malaysian adults. The study included a representative sample of adults aged 18-59 years (n=7349) from a nationwide Food Consumption Survey conducted by the Ministry of Health. Information on dietary intake was obtained using a one day 24-hour diet recall (24-HDR). Dietary data on 6886 adults were analysed using Nutritionist ProTM and statistical analysis was carried out using the SPSS 13.0. The median percentage of daily energy intake is reported only for adults consuming meals and afternoon tea and by socio-demographic characteristics as well as body mass index (BMI) status. More than 80% of Malaysian adults consumed morning meals, lunch and dinner and 54% reported having afternoon tea. The median percentage of energy intake from morning meals, lunch, dinner and afternoon tea was 29.9%, 30.5%, 32.4% and 17%, respectively. There were variations in the median percentage of energy from meals and snacks according to the socio-demographic variables and BMI status. It is important to understand the eating patterns of Malaysians as the information can assist in efforts to address obesity and diet-related chronic diseases among adults.

Food Consumption Patterns: Findings from the Malaysian Adult Nutrition Survey (MANS)

This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one- year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2½ plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy (ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk.

Energy and Nutrient Intakes: Findings from the Malaysian Adult Nutrition Survey (MANS)

Nutrition surveys based on a representative sample of the Malaysian adult population have hitherto not been reported. In 2003, the Ministry of Health, Malaysia, conducted the Malaysian Adult Nutrition Survey (MANS), the first and largest nutrition survey in the country which aimed to provide detailed quantitative information on nutritional status, food and nutrient intakes, and physical activity pattern on a nationwide representative sample of adult subjects between the ages of 18 and 59 years. The survey covered four zones in Peninsular Malaysia (Central, Southern, Northern and East Coast), Sabah and Sarawak. This paper presents the mean and selected percentiles of energy and nutrient intake of 6886 subjects by selected demographic and socioeconomic characteristics. Energy contributions by macronutrients and dietary adequacy in relation to the Recommended Nutrient Intake for Malaysians are also described. Information on dietary intake was collected by trained nutritionists using a one day 24-hour diet recall. Dietary data were analysed using Nutritionist Pro, a diet analysis software and statistical analysis was carried out using the SPSS ver. 13.0. In most of the demographic and socioeconomic groups, males had higher mean energy (1776 kcal) and nutrient intake and percent achievement of RNI than females (1447 kcal). The proportions of calories derived from macronutrients were within the recommendations for a healthy diet. Intake of micronutrients such as iron, calcium and vitamin A was about 50% of RNI particularly in women. Sodium intake of Malaysians, not reported in earlier studies, is also made available. Under-reporting using the EI/BMR ratio was found in half of the population studied. The present study provides the first national estimates of energy and nutrient intake of the Malaysian adult population. Regular nutrition surveys are needed at the national level to provide valuable information on trends in food and nutrient intake, particularly among age and ethnically diverse subgroups of the population.

Sex and ethnic differentials in physical activity levels of adolescents in kuantan

A cross-sectional study was conducted to determine the physical activity levels of 400 adolescents (13 years old) in Kuantan, Pahang using the Physical Activity Questionnaire for Older Children (PAQ-C). The associations of physical activity levels with sex, ethnicity and body mass index were also determined. About one third (35.3%) of the adolescents were in the low physical activity level category, 61.5% in the moderate physical activity level and only 3.0% of the adolescents were in the high physical activity level category. More males (77.9%) were physically active than females (54.9%). Twice as many female adolescents (45.1%) were in the low physical activity level category compared to the male adolescents (22.1%). The associations between physical activity with ethnicity and body mass index were not significant. However, there was a significant interaction effect of sex and ethnicity in mean physical activity score (F = 2.36, p<0.01). Malay males had a significantly higher mean physical activity score as compared to Chinese males (t=2.13; p<0.05). Although Chinese females had a higher mean physical activity score than Malay females, the difference was not statistically significant. Conversely, there was no interaction effect of sex and BMI status in mean physical activity score. This study suggests that physical activity intervention to promote regular physical activity is needed since a high proportion of the adolescents fall within the low physical activity level category.

Dietary intake, physical activity and energy expenditure of Malaysian adolescents

INTRODUCTION

Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality. While the aetiology of obesity is multi-factorial, the roles of diet and physical activity are controversial. Thus, the purpose of this study was to report on the differences in energy intake, diet composition, time spent doing physical activity and energy expenditure among underweight (UW), normal weight (NW) and at-risk of overweight (OW) Malaysian adolescents (317 females and 301 males) aged 11-15 years.

METHODS

This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index (BMI) categorisation. A total of 618 subjects were randomly selected from each BMI category according to gender. The subjects' dietary intake and physical activity were assessed using self-reported three-day food and activity records, respectively. Dietary intake components included total energy and macronutrient intakes. Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity. Time spent (in minutes) in low, medium and high intensity activities was also calculated.

RESULTS

The OW adolescents had the highest crude energy intake and energy expenditure. However, after adjusting for body weight, the OW subjects had the lowest energy intake and energy expenditure (p-value is less than 0.001). The study groups did not differ significantly in time spent for low, medium and high intensity activities. Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups (p-value is less than 0.05). All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate, respectively.

CONCLUSION

The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents. To prevent overweight and obesity among children and adolescents, strategies that address eating behaviours and physical activity are required. Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents.

Estimates and distribution of body mass index in a sample of Malaysian adolescents

The purpose of this study was to report on the estimates and distribution of body mass index in a sample of Malaysian adolescents. The study utilized a cross-sectional design and multi-stage random sampling of secondary schools to select 5 urban and 9 rural schools in Kedah and Penang. A total of 6555 male and female adolescents (11-15 years old) of Malay, Chinese and Indian ethnic groups were measured for weights and heights for body mass index calculation. Information on household demographic and socioeconomic were obtained from parents through self-administered questionnaires. Analyses of body mass index distribution by location, ethnicity, gender and age were conducted using Chi-square test of SPSS 11.5. More of the rural (12.1%) and urban (19.4%) adolescents were underweight and overweight, respectively. While in all ethnic, gender and age groups, rural adolescents were more likely to be underweight, more of the urban adolescents were overweight. The prevalence of underweight was highest among the Indians (19.2%) and lowest in Chinese (7.2%). The prevalence of overweight in the three ethnic groups was in the range of 18-19%. More male than female adolescents were underweight (15% vs 7.8%) and overweight (19.5% vs 16.7%). Consistent patterns were also observed across location, ethnic and age groups. As age increased, the prevalence of overweight decreased across the ethnic and gender groups. The reported findings can serve as current reference on body mass index distribution of Malaysian adolescents and a basis for future efforts in health and nutrition interventions for Malaysian children and adolescents.

Parental perceptions of children's body shapes

The aim was to determine the differences in parents' perceptions of boys' and girls' body shapes and the explanations for the emphasis on body shape care of children. Subjects were low-income parents (n = 158) of preschoolers attending preschools in Kuala Lumpur, Malaysia. Parental perceptions of children's body shapes were assessed based on their rankings (scale of 1 to 7) of four attributes (ideal, healthy, fat and thin) for boy and girl figures. Parental responses to five questions on the importance of body shape were also obtained. Parental rankings of ideal and healthy body shapes were significantly lower for girls than boys (p < 0.001). However, mothers' and fathers' rankings of boys' and girls' body shapes were not significantly different. for both boys and girls, parental ratings for ideal body shape were significantly lower than for healthy body shape (p < 0.001). The majority of parents indicated that children's body shape is important for their future health, self enhancement, social interaction and career. With the increasing prevalence of body dissatisfaction among Malaysian children, these findings contribute to the understanding of parental roles in the development of body image and perhaps, in the etiology of body dissatisfaction among children.

Food security and child nutritional status among Orang Asli (Temuan) households in Hulu Langat, Selangor

This study was conducted to determine the prevalence of household food insecurity and its potential risk factors and outcomes among the Orang Asli (Temuan) households. Socioeconomic, demographic and food security information of the households and anthropometric measurements and dietary intakes of preschoolers (n = 64) were obtained using a structured questionnaire. Food security was assessed using the Radimer/Cornell hunger and food insecurity instrument. Diet quality was based on 24 hour recall and analyzed according to the Malaysian RDA and Food Guide Pyramid. Majority of the households (82%) reported some kind of household food insecurity. The prevalence of significant underweight, stunting and wasting were 45.3%, 51.6% and 7.8%, respectively. Dietary intakes were less than 2/3 RDA levels for calories, calcium and iron. However, the intakes of protein, vitamin A, vitamin C and niacin exceeded the RDA and the sources for these nutrients were mainly rice, fish and green leafy vegetables. Among the five food groups, only the number of servings from cereals/cereal products/tubers group was achieved while that of the milk/diary products was the worst. Majority of the children (68.7%) had poor, 31.3% had fair and none with excellent diet quality. In general, diet quality and nutritional status of the children decreased as household food insecurity worsened. It is recommended that the nutritional problems of Orang Asli children be addressed through health, nutrition and economic programs and further studies should be carried out on determinants and consequences of household food insecurity.