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Improvement of dietary quality with the aid of a low glycemic index diet in Asian patients with type 2 diabetes mellitus

Barakatun Nisak MY, Ruzita AT, Norimah AK, Gilbertson H, Nor Azmi K

J Am Coll Nutr, 2010 Jun;29(3):161-70.
PMID: 20833988 DOI: 10.1080/07315724.2010.10719830

OBJECTIVES: This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM).

METHODS: Asian patients with T2DM (N = 104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record.

RESULTS: At week 12, both groups achieved the recommendations for carbohydrate (52 ± 4% and 54 ± 4% of energy) and fat (30 ± 4% and 28 ± 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A(1c) level at week 12 for patients in the lowest GI/GL quartile (Δ = -0.7 ± 0.1%) compared with those in the highest GI/GL quartile (Δ = -0.1 ± 0.2%).

CONCLUSIONS: These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM.
Fulltext The effect of low glycemic index bread eaten with different fillings on blood glucose response in healthy individuals

Barakatun Nisak Mohd Yusof, Ruzita Abd. Talib, Norimah A. Karim, Nor Azmi Kamarudin, Fatimah Arshad

Jurnal Sains Kesihatan Malaysia, 2008;6(1):1-10.
MyJurnal

White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.
Fulltext Juara sihat™: study design of a school-based childhood obesity nutrition education programme in Kuala Lumpur, Malaysia

Devanthini Dewi Gunasekaran, Ruzita Abd Talib, Razinah Sharif, Poh Bee Koon, Nik Shanita Safii, Mahadir Ahmad

Jurnal Sains Kesihatan Malaysia, 2018;16(101):119-127.
MyJurnal

The global prevalence of overweight and obesity among children has increased rapidly in the recent decades, including in Malaysia. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed. This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimed at managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition education programme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits and physical activity level among overweight and obese children. This quasi-experimental study involves two primary schools in Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweight and obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition education classes on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers. The control school does not receive any interventions. The primary outcome is BMI-for-age z-score, while other outcomes include waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentary behaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1 (3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promising approach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment of Parents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development of more effective strategies in formulating childhood obesity interventions.
Fulltext Development and validation of a food frequency questionnaire for dietary intake assessment among multi-ethnic primary school-aged children

Fatihah F, Ng BK, Hazwanie H, Norimah AK, Shanita SN, Ruzita AT, et al.

Singapore Med J, 2015 Dec;56(12):687-94.
PMID: 26702165 DOI: 10.11622/smedj.2015190

This study aimed to develop and validate a food frequency questionnaire (FFQ) to assess habitual diets of multi-ethnic Malaysian children aged 7-12 years.
Fulltext Intervention on whole grain with healthy balanced diet to manage childhood obesity (GReat-Child™trial): study protocol for a quasi-experimental trial

Koo HC, Poh BK, Ruzita AT

Springerplus, 2016;5(1):840.
PMID: 27386289 DOI: 10.1186/s40064-016-2431-y

The rapid increase in childhood obesity is a serious public health problem, and has led to the development of many interventions. However, no intervention has emphasized whole grains as a strategy to manage childhood obesity. Therefore, this article describes the protocol of a 12-week multi-component, family-based intervention on whole grain, using a healthy balanced diet for managing childhood obesity.
Fulltext Breakfast eating pattern and ready-to-eat cereals consumption among schoolchildren in Kuala Lumpur

Koo HC, Abdul Jalil SN, Ruzita AT

Malays J Med Sci, 2015;22(1):32-9.
PMID: 25892948

BACKGROUND: Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur.
METHODS: In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24-hour dietary recalls) were obtained.
RESULTS: Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs.
CONCLUSION: The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.
KEYWORDS: Malaysia; breakfast; calorie; cereals; children
Fulltext Factors influencing sustainability of juara sihat obesity intervention from the perspective of children: a qualitative study

Mok, Wilfred Kok Hoe, Devanthini Dewi Gunasekaran, Wee, Lei Hum, Poh, Bee Koon, Ruzita Abd. Talib

Jurnal Sains Kesihatan Malaysia, 2019;17(3):157-167.
MyJurnal

Global prevalence of childhood overweight and obesity have increased drastically in the past years, including in Malaysia. School-based obesity intervention is important to promote healthy eating and behavioural change. Many obesity interventions have been conducted to combat childhood obesity; however, the sustainability of childhood obesity interventions are often overlooked. This study aimed to explore the factors that influenced sustainability of Juara Sihat intervention programme in Kuala Lumpur primary school. Face-to-face in-depth interviews were conducted with 26 children aged 12- 14 years old whom participated in the Juara Sihat intervention programme were purposively selected. Data was transcribed verbatim and analysed using thematic analysis. The main themes identified as motivators are (1) support from family, facilitators, school teachers, and friends; (2) physical activity and healthy eating practices after intervention; (3) self-awareness; (4) knowledge on food pyramid and healthy eating; and (5) home environment. While the barriers are (1) knowledge inconsistency; (2) own safety; (3) peers influence; (4) self-attitude; (5) boredom towards programme. The results showed that the main promoting factor for sustainability of Juara Sihat intervention programme is continued practice of physical activity and healthy eating, while the main barrier is knowledge inconsistency. Therefore, school-based obesity intervention programmes should consider these promoting and hindering factors that could influence the sustainability of intervention programmes. Future studies should consider those factors during program intervention planning especially when factors that influence implementation and sustainability are carefully considered and taken care of to ensure long-term success.
Fulltext Validity and Reliability of a Food Frequency Questionnaire (FFQ) to Assess Dietary Intake of Preschool Children

Noor Hafizah Y, Ang LC, Yap F, Nurul Najwa W, Cheah WL, Ruzita AT, et al.

Int J Environ Res Public Health, 2019 11 27;16(23).
PMID: 31783477 DOI: 10.3390/ijerph16234722

As there are few food frequency questionnaires (FFQ) to assess the dietary intake of preschool children, this study examined the validity and reliability of an FFQ for this purpose. A total of 210 preschoolers aged 4 to 6 years participated in the validation study, while a subsample of 66 participants joined the reliability study. The FFQ is modified from the ToyBox-study and South East Asian Nutrition Surveys (SEANUTS), and comprised 108 food items from 13 food groups. A three-day estimated dietary record (3DR) was used as reference and reliability was assessed through a second administration of the FFQ (FFQ2), four weeks after the first administration (FFQ1). For the validation study, Spearman's correlation coefficients showed moderate to high correlations (p < 0.001) between FFQ and 3DR. Cross-classification of quartile analysis showed moderate agreement between the two methods. As for reliability, Spearman's correlation coefficients showed moderate to high correlations (p < 0.001) between FFQ1 and FFQ2. Cronbach's alpha values (0.708 to 0.824) and intraclass correlation coefficients (0.710 to 0.826) showed good agreement between repeated FFQs. The results suggest that the FFQ has acceptable validity and good reliability. Hence, the FFQ can be used to assess preschool children's food intake.
Fulltext Nutrition labelling: an exploratory study on personal factors that influence the practice of reading nutrition labels among adolescents

Norsakira Jefrydin, Norazmir Md Nor, Ruzita Abd. Talib

Malays J Nutr, 2019;25(1):143-153.
MyJurnal

Introduction: The consumption of processed food is increasing in developing
countries. Nutrition labels on food packaging are important for the education of
consumers, particularly adolescents, to help them make healthier food choices.
However, there is evidence to suggest that adolescents generally do not use nutrition
labels. This study aims to explore the personal factors that influence the practice of
Malaysian adolescents in reading nutrition labels. Methods: The participants were
adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five
semi-structured focus group discussions (FGDs) were conducted. The participants
discussed their personal views, knowledge and perceptions regarding the use of
nutrition labels and food selection. Data gathered from the FGDs were coded through
thematic analysis using the NVivo software. Results: While the participants were
familiar with nutrition labels, their usage was relatively low during food selection
due to the lack of interest in nutrition information, past experiences, hunger and
cravings, time constraints and the taste of the food. The main reasons for using
nutrition labels were health consciousness and their curiosity about specific
nutrition information provided on the labels. The majority of participants believed
that information provided on the labels was accurate because it was provided by
reliable institutions. There was also misperception among some participants, mixing
up nutrition labels with list of ingredients and the expiry dates. A few participants
were unconvinced by the labels and stated that the labels provided misleading
information. Conclusion: Personal factors such as knowledge, misperception,
awareness and trust significantly impact how adolescents read nutrition labels.
Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia)

Poh BK, Ng BK, Siti Haslinda MD, Nik Shanita S, Wong JE, Budin SB, et al.

Br J Nutr, 2013 Sep;110 Suppl 3:S21-35.
PMID: 24016764 DOI: 10.1017/S0007114513002092

The dual burden of malnutrition reportedly coexists in Malaysia; however, existing data are scarce and do not adequately represent the nutritional status of Malaysian children. The Nutrition Survey of Malaysian Children was carried out with the aim of assessing the nutritional status in a sample of nationally representative population of children aged 6 months to 12 years. A total of 3542 children were recruited using a stratified random sampling method. Anthropometric measurements included weight, height, mid-upper arm circumference, and waist and hip circumferences. Blood biochemical assessment involved analyses of Hb, serum ferritin, and vitamins A and D. Dietary intake was assessed using semi-quantitative FFQ, and nutrient intakes were compared with the Malaysian Recommended Nutrient Intakes (RNI). The prevalence of overweight (9·8%) and obesity (11·8%) was higher than that of thinness (5·4%) and stunting (8·4%). Only a small proportion of children had low levels of Hb (6·6%), serum ferritin (4·4%) and vitamin A (4·4%), but almost half the children (47·5%) had vitamin D insufficiency. Dietary intake of the children was not compatible with the recommendations, where more than one-third did not achieve the Malaysian RNI for energy, Ca and vitamin D. The present study revealed that overnutrition was more prevalent than undernutrition. The presence of high prevalence of vitamin D insufficiency and the inadequate intake of Ca and vitamin D are of concern. Hence, strategies for improving the nutritional status of Malaysian children need to consider both sides of malnutrition and also put emphasis on approaches for the prevention of overweight and obesity as well as vitamin D insufficiency.
Waist circumference percentile curves for Malaysian children and adolescents aged 6.0-16.9 years

Poh BK, Jannah AN, Chong LK, Ruzita AT, Ismail MN, McCarthy D

Int J Pediatr Obes, 2011 Aug;6(3-4):229-35.
PMID: 21668385 DOI: 10.3109/17477166.2011.583658

BACKGROUND: The prevalence of obesity is increasing rapidly and abdominal obesity especially is known to be a risk factor for metabolic syndrome and other non-communicable diseases. Waist circumference percentile curves are useful tools which can help to identify abdominal obesity among the childhood and adolescent populations.
OBJECTIVE: To develop age- and sex-specific waist circumference (WC) percentile curves for multi-ethnic Malaysian children and adolescents aged 6.0-16.9 years. Subjects and methods. A total of 16,203 participants comprising 8,093 boys and 8,110 girls recruited from all regions of Malaysia were involved in this study. Height, weight, WC were measured and BMI calculated. Smoothed WC percentile curves and values for the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th percentiles were constructed using the LMS Method.
RESULTS: WC was found to increase with age in both sexes, but boys had higher WC values at every age and percentile. Z-scores generated using the UK reference data shows that Chinese children had the highest WC compared to Malays, Indians and other ethnicities. Comparisons with other studies indicate that at the 50th percentile, Malaysian curves did not differ from the UK, Hong Kong and Turkish curves, but at the 90th percentile, Malaysian curves were higher compared with other countries, starting at 10 years of age. The 90th percentile was adopted as the cut-off point to indicate abdominal obesity in Malaysian children and adolescents.
CONCLUSION: These curves represent the first WC percentiles reported for Malaysian children, and they can serve as a reference for future studies.
Fulltext 25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEANUTS)

Poh BK, Rojroongwasinkul N, Nguyen BK, Sandjaja, Ruzita AT, Yamborisut U, et al.

Asia Pac J Clin Nutr, 2016;25(3):538-48.
PMID: 27440689 DOI: 10.6133/apjcn.092015.02

The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (>=75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (>=75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options.
Triple burden of malnutrition among Malaysian children aged 6 months to 12 years: Current findings from SEANUTS II Malaysia

Poh BK, Wong JE, Lee ST, Chia JSM, Yeo GS, Sharif R, et al.

Public Health Nutr, 2023 Nov 07.
PMID: 37932916 DOI: 10.1017/S1368980023002239

OBJECTIVE: This paper aims to report South East Asian Nutrition Surveys (SEANUTS) II Malaysia data on nutritional status, dietary intake, and nutritional biomarkers of children aged 6 months to 12 years.
DESIGN: Cross-sectional survey conducted in 2019-2020.
SETTING: Multistage cluster sampling conducted in Central, Northern, Southern, and East Coast regions of Peninsular Malaysia.
PARTICIPANTS: 2989 children aged 0.5-12.9 years.
RESULTS: Prevalences of stunting, thinness, overweight, and obesity among children aged 0.5-12.9 years were 8.9%, 6.7%, 9.2%, and 8.8%, respectively. Among children below 5 years old, 11.4% were underweight, 13.8% had stunting, and 6.2% wasting. Data on nutritional biomarkers showed a small proportion of children aged 4-12 years had iron (2.9%) and vitamin A deficiencies (3.1%). Prevalence of anaemia was distinctly different between children below 4 years old (40.3%) and those aged 4 years and above (3.0%). One-fourth of children (25.1%) had vitamin D insufficiency, which was twice as prevalent in girls (35.2% vs. boys: 15.6%). The majority of children did not meet the recommended dietary intake for calcium (79.4%) and vitamin D (94.8%).
CONCLUSIONS: Data from SEANUTS II Malaysia confirmed that triple burden of malnutrition co-exists among children in Peninsular Malaysia, with higher prevalence of overnutrition than undernutrition. Anaemia is highly prevalent among children below 4 years old, while vitamin D insufficiency is more prevalent among girls. Low intakes of dietary calcium and vitamin D are also of concern. These findings provide policymakers with useful and evidence-based data to formulate strategies that address the nutritional issues of Malaysian children.
Fulltext From ToyBox Study to eToyBox: Advancing Childhood Obesity Reduction in Malaysian Kindergartens

Reeves S, Poh BK, Chong YT, Lee JAC, Cheah WL, Hafizah YN, et al.

Int J Environ Res Public Health, 2023 Aug 20;20(16).
PMID: 37623197 DOI: 10.3390/ijerph20166614

Prevention and treatment of childhood obesity is a global concern, and in Malaysia, it is considered a national public health priority. Determinants of childhood obesity are multifactorial and include factors that directly and indirectly influence energy balance-related behaviours, including energy intake and energy expenditure. Interventions to address childhood obesity that have multiple components at different levels have been shown to be the most influential. The ToyBox-study is a childhood obesity intervention aimed at preschool-aged children and their families that had been shown to be effective in several European countries and so was chosen for adaption for the Malaysian setting. Materials were translated and adjusted for the Malaysian context and audience and implemented in kindergartens in Peninsular Malaysia and Sarawak. However, during the COVID-19 pandemic and lockdown, teaching transitioned to being online. This brought an opportunity to reach a wider audience and consider the long-term sustainability of the intervention, and thus eToybox was born. eToybox aims to bring support for healthy energy balance behaviours directly to the teachers, into kindergartens and homes, to encourage families to be active and eat healthily, and prevent or reduce obesity. Through online innovation, the Toybox Study Malaysia programme has been expanded to enhance its potential to impact the promotion of healthy lifestyles among preschoolers and their families, highlighting the importance of a holistic approach to preventing and treating childhood obesity in Malaysia.
Fulltext Penilaian media bercetak untuk pendidikan pemakanan kanak-kanak berlebihan berat badan dan obes

Ruzita Abd Talib, Lim, Shi Han, Hanee Fakhrurazi, Siti Sabariah Buhari, Poh, Bee Koon

Jurnal Sains Kesihatan Malaysia, 2013;11(2):55-62.
MyJurnal

Media pendidikan bercetak merupakan saluran komunikasi yang utama dalam pendidikan kesihatan awam. Namun, kajian tempatan yang menilai penerimaan media pendidikan bercetak masih terhad di Malaysia. Maka, kajian ini dilakukan untuk menilai media pendidikan bercetak sedia ada yang mensasarkan obesiti di kalangan kanak-kanak untuk kegunaan dalam program pendidikan atau promosi pemakanan. Kajian ini melibatkan dua peringkat. Peringkat pertama merupakan tinjauan keperluan iaitu tinjauan terhadap media pendidikan bercetak sedia ada yang mensasarkan kanak kanak yang mengalami masalah berlebihan berat badan dan obes dan kajian rintis terhadap borang soal selidik yang dibentuk. Manakala peringkat kedua adalah penilaian penerimaan subjek kajian terhadap media pendidikan bercetak dan perubahan tahap pengetahuan mereka selepas membaca media pendidikan bercetak yang diberikan. Skala Likertn digunakan dalam penilaian ini iaitu daripada 1 (sangat tidak memuaskan) hingga 5 (sangat memuaskan). Jumlah subjek dalam kajian ini adalah seramai 67 orang yang terdiri daripada golongan profesional dalam bidang pendidikan dan kesihatan (n = 7), subjek dewasa (n = 30) dan subjek kanak-kanak (n = 30). Di dalam kajian ini, subjek dewasa diberi satu buku kecil yang mengandungi maklumat berkenaan pencegahan dan pengurusan masalah obesiti di kalangan kanak-kanak seperti komplikasi masalah obesiti dan penyediaan makanan. Subjek kanak-kanak pula menerima satu buku kecil yang mengandungi maklumat berkenaan piramid makanan, kepentingan sarapan, aktiviti fi zikal dan sebagainya di samping satu poster yang mengandungi maklumat berkenaan pemilihan makanan sihat. Manakala golongan profesional menerima semua media pendidikan bercetak ini. Kajian ini mendapati penerimaan subjek terhadap isi kandungan, gambar, jadual dan rajah, warna, susun atur gambar, susun atur kandungan, bahasa dan saiz huruf bagi ketiga-tiga media pendidikan bercetak adalah pelbagai, iaitu daripada sangat tidak memuaskan hingga sangat memuaskan. Min skor penilaian keseluruhan terhadap buku kecil yang mensasarkan populasi dewasa adalah 3.9 ± 0.5 manakala min skor penilaian keseluruhan terhadap buku kecil yang mensasarkan populasi kanak-kanak adalah 4.3 ± 0.4 dan poster adalah 3.9 ± 0.9. Skor pengetahuan pemakanan golongan profesional meningkat dari 88.6 ± 11.2% kepada 95.5 ± 3.2% selepas membaca media tersebut. Skor pengetahuan pemakanan subjek dewasa juga meningkat secara signifi kan (p < 0.001)daripada 67.7 ± 13.6% kepada 84.8 ± 15.9%; bagi subjek kanak-kanak, skor pengetahuan pemakanan juga meningkat secara signifi kan (p < 0.001) daripada 65.3 ± 14.4% kepada 84.0 ± 11.4%. Kesimpulannya, media pendidikan bercetak sedia ada mendapat penerimaan yang baik dan dapat meningkatkan tahap pengetahuan kumpulan sasaran. Oleh itu, media pendidikan bercetak tersebut sesuai digunakan dalam mana-mana program pendidikan pemakanan yang berkaitan dengan obesiti kanak-kanak.
Physical activity of pediatric patients with acute leukemia undergoing induction or consolidation chemotherapy

Tan SY, Poh BK, Chong HX, Ismail MN, Rahman J, Zarina AL, et al.

Leuk. Res., 2013 Jan;37(1):14-20.
PMID: 23099236 DOI: 10.1016/j.leukres.2012.09.005

This study aimed to assess the physical activity levels of pediatric patients with acute leukemia undergoing chemotherapy. Thirty-eight pediatric patients and matched controls, aged 3-12 years old, were measured for weight, height, and other anthropometric parameters. Physical activity was assessed using actical accelerometer and activity log book. Patients recorded significantly lower mean total activity counts (26.2±30.2 cpm vs. 192.2±68.8 cpm; p<0.01) and spent more time in sedentary activities (1301±121 min vs. 1020±101 min; p<0.001) compared to controls. They also achieved fewer 1-5-min bouts of moderate-vigorous physical activity (MVPA) compared to controls (1.50±5.95 vs. 37.38±40.36; p<0.001). In conclusion, patients had lower physical activity level and intensity; and simple exercise intervention programs may be needed to minimize the detrimental effects of prolonged sedentary behaviors.
Fulltext Development of sports nutrition educational tools (NutrisportExTM): a web-application for Malaysian national athletes

Tsin, Chan Yein, Nik Shanita Safii, Abdul Hadi Abd Rahman, Norafifah Ahmad Shabri, Mohd Izham Mohamad, Azimah Ahmad, et al.

Movement Health & Exercise, 2017;6(2):61-70.
MyJurnal

The use of electronics or technology, to improve the subjects’ knowledge,
attitude, and practice (KAP) in nutrition or their compliance in recording their
diet, for general primary care is not uncommon. However, there are more to
be explored to improve sports nutrition KAP. The objective of this study was
to develop a web app tool for athletes to increases their KAP in sports
nutrition and to test on their acceptance towards the web app tool. This study
was divided into 3 phases. Phase I involves the development of the web app.
In Phase II, a focus group of 20 people was recruited to test the web app tool.
Phase III was to evaluate the effectiveness of the web app in increasing
athletes’ sports nutrition KAP and their acceptance of the web app. 30 athletes
were recruited to use this web app for a week, a PRE- and POST-intervention
KAP questionnaire were given. There was a strong correlation between
athletes’ attitude towards this tool and intention to use in the future (r = 0.675).
The more this web app tool was perceived as useful, the more likely they will
visit the web app (r = 0.589). Although the web app was well-accepted among
the athletes, their KAP score was significantly reduced after the intervention
(p= 0.011). The reduction of scores was due to the lack of consistent usage on the web app. In conclusion, it requires more facilitating support from the
coach, longer training time, reminders, and entertainment features for
consistent usage, to improve the athletes’ KAP in sports nutrition via the web
app.
Fulltext Impact of the fit, eat, active, training (F.E.A.T) program on nutritional status and physical activity among overweight adult

Wirdah, M., Poh, B. K., Ruzita Abd Talib, Nor Farah, M. F., Norhayati, I.

Jurnal Sains Kesihatan Malaysia, 2020;18(1):71-83.
MyJurnal

Behavioural change interventions for weight loss have been found to be effective in the short term, but their long-term effectiveness remains a question. The objective of this study was to evaluate the effectiveness of the 36 weeks F.E.A.T program combining behavioural changes of healthy eating and physical activity. A quasi-experimental study of overweight adults was conducted in Malacca. A total of 53 subjects (mean age 47.4 ± 7.2 years) completed the program in three stages. In the first stage (T1: weeks 1–12), the intervention group (n = 28) participated in the F.E.A.T program activities, while the control group (n = 25) did not receive the intervention. In the second stage (T2: weeks 13-24), the activity was supervised and monitored by the peer support group. Sustainability of activity was measured at the third stage (T3: weeks 25-36). The effectiveness of the program was measured by changes in dietary intake, physical activity score, body weight, body mass index (BMI), waist circumference (WC) and body fat percentage at T0 (pre-intervention), T1, T2 and T3. All parameters showed significant interaction effects (time*group) except for energy intake. The intervention group showed significant decreases from T0 to T3 for energy intake (-14.3%), body weight (-4.3%), BMI (-4.2%), WC (-10.5%) and body fat percentage (-3.6%). While physical activity level increased by 109.6% for the intervention group. There were no significant differences in all of these parameters among the control group. The results show the effectiveness of the F.E.A.T program on dietary status and physical activity changes during the 36-week of intervention period.
Fulltext International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years

Xi B, Zong X, Kelishadi R, Litwin M, Hong YM, Poh BK, et al.

J Clin Endocrinol Metab, 2020 04 01;105(4).
PMID: 31723976 DOI: 10.1210/clinem/dgz195

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents.
OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk.
DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years).
MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization.
RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls).
CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

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