OBJECTIVE: The study aimed to derive dietary patterns empirically and to examine the consistency and generalizability of patterns across sex, ethnicity, and urban status in a working population.

DESIGN: This was a cross-sectional study using data from the Clustering of Lifestyle Risk Factors and Understanding its Association with Stress on Health and Well-Being among School Teachers in Malaysia study collected between August 2014 and November 2015. Dietary intake was assessed using a food frequency questionnaire, and dietary patterns were derived using factor analysis.

PARTICIPANTS/SETTING: Participants were teachers from selected public schools from three states in Peninsular Malaysia (n=4,618).

MAIN OUTCOME MEASURES: Dietary patterns derived using factor analysis.

STATISTICAL ANALYSES PERFORMED: Separate factor analysis was conducted by sex, ethnicity, and urban status to identify dietary patterns. Eigenvalue >2, scree plot, Velicer's minimum average partial analysis, and Horn's parallel analysis were used to determine the number of factors to retain. The interpretability of each dietary pattern was evaluated. The consistency and generalizability of dietary patterns across subgroups were assessed using the Tucker congruence coefficient.

RESULTS: There was no subgroup-specific dietary pattern found. Thus, dietary patterns were derived using the pooled sample in the final model. Two dietary patterns (Western and Prudent) were derived. The Western dietary pattern explained 15.4% of total variance, characterized by high intakes of refined grains, animal-based foods, added fat, and sugar-sweetened beverages as well as fast food. The Prudent dietary pattern explained 11.1% of total variance and was loaded with pulses, legumes, vegetables, and fruits.

METHODS: We performed a systematic search of relevant studies on Ovid (MEDLINE), EMBASE, the Cochrane Library, Web of Science, Scopus and grey literature databases. At least two authors independently conducted the literature search, selecting eligible studies, and extracting data. Meta-analysis using random-effects model was conducted to compute the pooled odds ratio with 95% confidence intervals (CI).

FINDINGS: We obtained a total of 13,333 articles from the searches. For the final analysis, we included a total of fifteen studies among pediatric patients. Three cohort studies, two case-control studies, and one cross-sectional study found an association between obesity and dengue severity. In contrast, six cohort studies and three case-control studies found no significant relationship between obesity and dengue severity. Our meta-analysis revealed that there was 38 percent higher odds (Odds Ratio = 1.38; 95% CI:1.10, 1.73) of developing severe dengue infection among obese children compared to non-obese children. We found no heterogeneity found between studies. The differences in obesity classification, study quality, and study design do not modify the association between obesity and dengue severity.

METHODOLOGY: A total of nine focus group discussions with 56 farmworkers across eight animal farms in Peninsular Malaysia were conducted between August and October 2013.

RESULTS: Farmworkers explained their experience of tick bites, but no one reported TBDs. Many farmworkers indicated that they did not seek any medical treatment. There was a misconception that ticks are solely pathogenic to farm animals. Farmworkers perceived low severity and susceptibility of tick bites, and low self-efficacy of tick bite prevention, however, a group also perceived susceptibility to getting tick bites due to the characteristics of their job. Barriers for prevention were related to the perception and knowledge towards ticks. Farmworkers requested information about TBDs.