Displaying publications 1 - 20 of 32 in total

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  1. Zulfarina MS, Sharif R, Sharkawi AM, Mokhtar SA, Shuid AN, Naina-Mohamed I
    Public Health Nutr, 2023 Jan;26(1):122-131.
    PMID: 35321764 DOI: 10.1017/S1368980022000726
    OBJECTIVE: Misreporting of energy intake (EI) in nutritional epidemiology is common and even severe among adolescents. Thus, the current study aims to examine the presence, bias and impact introduced by implausible reporters.

    DESIGN: Cross-sectional.

    SETTING: Central and eastern regions of Peninsular Malaysia.

    PARTICIPANTS: A stratified random sampling was employed to select 917 secondary school-going adolescents (aged 15-17 years).

    RESULTS: The prevalence of under-reporters was 17·4 %, while no over-reporters were identified. Under-reporters had higher body composition and lower dietary intakes (except for vitamin C, Cr and Fl) compared with plausible reporters (P < 0·05). Adolescents with overweight and obesity had a higher odds of under-reporting compared with under-/normal weight adolescents (P < 0·001). In model 3, the highest regression coefficient (R2 = 0·404, P < 0·001) was obtained after adjusting for reporting status.

    CONCLUSIONS: Overweight and obese adolescents were more likely to under-report their food intake and consequently affect nutrient intakes estimates. Future analyses that include nutrient intake data should adjust for reporting status so that the impact of misreporting on study outcomes can be conceded and consequently improve the accuracy of dietary-related results.

  2. Zainal Arifen ZN, Haron H, Shahar S, Harun Z, Michael V, You YX, et al.
    Public Health Nutr, 2023 Dec 15;27(1):e12.
    PMID: 38098442 DOI: 10.1017/S136898002300277X
    OBJECTIVE: To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

    DESIGN: A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.

    SETTING: Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.

    PARTICIPANTS: Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.

    RESULTS: Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.

    CONCLUSIONS: These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.

  3. Yong HY, Mohd Shariff Z, Appannah G, Rejali Z, Mohd Yusof BN, Bindels J, et al.
    Public Health Nutr, 2020 Dec;23(18):3304-3314.
    PMID: 32814606 DOI: 10.1017/S1368980020002372
    OBJECTIVE: To examine the gestational weight gain (GWG) trajectory and its possible association with pregnancy outcomes.

    DESIGN: GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories.

    SETTING: Negeri Sembilan, Malaysia.

    PARTICIPANTS: Two thousand one hundred ninety-three pregnant women.

    RESULTS: Three GWG trajectories were identified: 'Group 1 - slow initial GWG but followed by drastic GWG', 'Group 2 - maintaining rate of GWG at 0·58 kg/week' and 'Group 3 - maintaining rate of GWG at 0·38 kg/week'. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women.

    CONCLUSIONS: Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes.

  4. Swarna Nantha Y, Kalasivan A, Ponnusamy Pillai M, Suppiah P, Md Sharif S, Krishnan SG, et al.
    Public Health Nutr, 2020 Feb;23(3):402-409.
    PMID: 31538554 DOI: 10.1017/S1368980019002684
    OBJECTIVE: The development of a second version of the Yale Food Addiction Scale (YFAS) coincides with the latest updates in the diagnosis of addiction as documented in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The objective of the present study was to translate the YFAS 2.0 into the Malay language and test its psychometric properties in a primary-care population.

    DESIGN: Patients were assessed for food addiction utilizing the Malay YFAS 2.0. The participants were also assessed for eating disorder using the validated Malay Binge Eating Scale. The psychometric properties of the YFAS 2.0 were determined by analysing factor structure, overall item statistics, internal consistency and construct validity.

    SETTING: Between 2017 and 2018, participants were chosen from a regional primary-care clinic in the district of Seremban, Malaysia.

    PARTICIPANTS: Patients (n 382) from a regional primary-care clinic.

    RESULTS: The prevalence of food addiction was 5·0%. A two-factor structure of the YFAS was confirmed as the most optimal solution for the scale via confirmatory factor analysis. In both its diagnostic and symptom count version, the YFAS 2.0 had good internal consistency (Kuder-Richardson α > 0·80 and McDonald's ω > 0·9).

    CONCLUSIONS: We validated a psychometrically sound Malay version of the YFAS 2.0 in a primary-care population. Both diagnostic and symptom count versions of the scale had robust psychometric properties. The questionnaire can be used to develop health promotion strategies to detect food addiction tendencies in a general population.

  5. Sreeramareddy CT, Ramakrishnareddy N, Subramaniam M
    Public Health Nutr, 2015 Nov;18(16):2906-14.
    PMID: 25435296 DOI: 10.1017/S1368980014002729
    OBJECTIVE: To examine the association between household food insecurity score and Z-scores of childhood nutritional status indicators.

    DESIGN: Population-based, cross-sectional survey, Nepal Demographic and Health Survey 2011.

    SETTING: A nationally representative sample of 11 085 households selected by a two-stage, stratified cluster sampling design to interview eligible men and women.

    SUBJECTS: Children (n 2591) aged 0-60 months in a sub-sample of households selected for men's interview.

    RESULTS: Prevalence of moderate and severe household food insecurity was 23·2% and 19·0%, respectively, for children aged 0-60 months. Weighted prevalence rates for stunting (height-for-age Z-score (HAZ)

  6. Shyam S, Khor GL, Ambak R, Mahadir B, Hasnan M, Ambu S, et al.
    Public Health Nutr, 2020 Feb;23(2):319-328.
    PMID: 31397262 DOI: 10.1017/S1368980019001861
    OBJECTIVE: To investigate the association between dietary patterns (DP) and overweight risk in the Malaysian Adult Nutrition Surveys (MANS) of 2003 and 2014.

    DESIGN: DP were derived from the MANS FFQ using principal component analysis. The cross-sectional association of the derived DP with prevalence of overweight was analysed.

    SETTING: Malaysia.

    PARTICIPANTS: Nationally representative sample of Malaysian adults from MANS (2003, n 6928; 2014, n 3000).

    RESULTS: Three major DP were identified for both years. These were 'Traditional' (fish, eggs, local cakes), 'Western' (fast foods, meat, carbonated beverages) and 'Mixed' (ready-to-eat cereals, bread, vegetables). A fourth DP was generated in 2003, 'Flatbread & Beverages' (flatbread, creamer, malted beverages), and 2014, 'Noodles & Meat' (noodles, meat, eggs). These DP accounted for 25·6 and 26·6 % of DP variations in 2003 and 2014, respectively. For both years, Traditional DP was significantly associated with rural households, lower income, men and Malay ethnicity, while Western DP was associated with younger age and higher income. Mixed DP was positively associated with women and higher income. None of the DP showed positive association with overweight risk, except for reduced adjusted odds of overweight with adherence to Traditional DP in 2003.

    CONCLUSIONS: Overweight could not be attributed to adherence to a single dietary pattern among Malaysian adults. This may be due to the constantly morphing dietary landscape in Malaysia, especially in urban areas, given the ease of availability and relative affordability of multi-ethnic and international foods. Timely surveys are recommended to monitor implications of these changes.

  7. Shinozaki N, Yuan X, Murakami K, Sasaki S
    Public Health Nutr, 2021 Feb;24(2):223-242.
    PMID: 32758321 DOI: 10.1017/S136898002000172X
    OBJECTIVE: To summarise the existing evidence of development, validation and current status of utilisation of dish-based dietary assessment tools.

    DESIGN: Scoping review.

    SETTING: Systematic search using PubMed and Web of Science.

    RESULTS: We identified twelve tools from seventy-four eligible publications. They were developed for Koreans (n 4), Bangladeshis (n 2), Iranians (n 1), Indians/Malays/Chinese (n 1), Japanese (n 3) and Chinese Americans (n 1). Most tools (10/12) were composed of a dish-based FFQ. Although the development process of a dish list varied among the tools, six studies classified mixed dishes based on the similarity of their characteristics such as food ingredients and cooking methods. Tools were validated against self-reported dietary information (n 9) and concentration biomarkers (n 1). In the eight studies assessing the differences between the tool and a reference, the mean (or median) intake of energy significantly differed in five studies, and 26-83 % of nutrients significantly differed in eight studies. Correlation coefficients for energy ranged from 0·15 to 0·87 across the thirteen studies, and the median correlation coefficients for nutrients ranged from 0·12 to 0·77. Dish-based dietary assessment tools were used in fifty-nine studies mainly to assess diet-disease relationships in target populations.

    CONCLUSIONS: Dish-based dietary assessment tools have exclusively been developed and used for Asian-origin populations. Further validation studies, particularly biomarker-based studies, are needed to assess the applicability of tools.

  8. Sharif Ishak SIZ, Chin YS, Mohd Taib MN, Mohd Shariff Z
    Public Health Nutr, 2020 Jun;23(8):1440-1449.
    PMID: 31915085 DOI: 10.1017/S1368980019003677
    OBJECTIVE: To explore the concepts of healthy eating and to identify the barriers and facilitating factors for dietary behaviour change in adolescents.

    DESIGN: A qualitative study involving twelve focus groups.

    SETTING: Two secondary schools in the district of Hulu Langat in Selangor, Malaysia.

    PARTICIPANTS: Seventy-two adolescents aged 13-14 years.

    RESULTS: Adolescents had some understanding regarding healthy eating and were able to relate healthy eating with the concepts of balance and moderation. The adolescents' perceptions of healthy and unhealthy eating were based on food types and characteristics, cooking methods and eating behaviours. Facilitators for healthy eating were parents' control on adolescents' food choices, feeling concern about own health and body, being influenced by other's health condition, and knowledge of healthy or unhealthy eating. On the other hand, barriers for healthy eating were the availability of food at home and school, taste and characteristics of foods, and lack of knowledge on healthy or unhealthy foods.

    CONCLUSIONS: The findings contribute to a better understanding of the adolescents' concept of healthy eating, as well as the facilitators and barriers to practising healthy eating. Future interventions should include a method of promoting the immediate benefits of healthy eating, the way to cope with environmental barriers for healthy eating, and increasing the availability of healthy food choices at home and in the school environment. The health and nutrition education programmes should also focus on educating parents, as they can be role models for adolescents to practise more healthful behaviours.

  9. Sandjaja S, Poh BK, Rojroongwasinkul N, Le Nguyen Bao K, Soekatri M, Wong JE, et al.
    Public Health Nutr, 2018 Nov;21(16):2972-2981.
    PMID: 29852879 DOI: 10.1017/S1368980018001349
    OBJECTIVE: The present study aimed to (i) calculate body-weight- and BMI-for-age percentile values for children aged 0·5-12 years participating in the South-East Asian Nutrition Survey (SEANUTS); (ii) investigate whether the pooled (i.e. including all countries) SEANUTS weight- and BMI-for-age percentile values can be used for all SEANUTS countries instead of country-specific ones; and (iii) examine whether the pooled SEANUTS percentile values differ from the WHO growth references.

    DESIGN: Body weight and length/height were measured. The LMS method was used for calculating smoothened body-weight- and BMI-for-age percentile values. The standardized site effect (SSE) values were used for identifying large differences (i.e. $\left| {{\rm SSE}} \right|$ >0·5) between the pooled SEANUTS sample and the remaining pooled SEANUTS samples after excluding one single country each time, as well as with WHO growth references.

    SETTING: Malaysia, Thailand, Vietnam and Indonesia.

    SUBJECTS: Data from 14 202 eligible children.

    RESULTS: The SSE derived from the comparisons of the percentile values between the pooled and the remaining pooled SEANUTS samples were indicative of small/acceptable (i.e. $\left| {{\rm SSE}} \right|$ ≤0·5) differences. In contrast, the comparisons of the pooled SEANUTS sample with WHO revealed large differences in certain percentiles.

    CONCLUSIONS: The findings of the present study support the use of percentile values derived from the pooled SEANUTS sample for evaluating the weight status of children in each SEANUTS country. Nevertheless, large differences were observed in certain percentiles values when SEANUTS and WHO reference values were compared.

  10. Rojroongwasinkul N, Bao Kle N, Sandjaja S, Poh BK, Boonpraderm A, Huu CN, et al.
    Public Health Nutr, 2016 Jul;19(10):1741-50.
    PMID: 26592313 DOI: 10.1017/S1368980015003316
    OBJECTIVE: Health and nutritional information for many countries in the South-East Asian region is either lacking or no longer up to date. The present study aimed to calculate length/height percentile values for the South-East Asian Nutrition Survey (SEANUTS) populations aged 0·5-12 years, examine the appropriateness of pooling SEANUTS data for calculating common length/height percentile values for all SEANUTS countries and whether these values differ from the WHO growth references.

    DESIGN: Data on length/height-for-age percentile values were collected. The LMS method was used for calculating smoothened percentile values. Standardized site effects (SSE) were used for identifying large or unacceptable differences (i.e. $\mid\! \rm SSE \!\mid$ >0·5) between the pooled SEANUTS sample (including all countries) and the remaining pooled SEANUTS samples (including three countries) after weighting sample sizes and excluding one single country each time, as well as with WHO growth references.

    SETTING: Malaysia, Thailand, Vietnam and Indonesia.

    SUBJECTS: Data from 14202 eligible children were used.

    RESULTS: From pair-wise comparisons of percentile values between the pooled SEANUTS sample and the remaining pooled SEANUTS samples, the vast majority of differences were acceptable (i.e. $\mid\! \rm SSE \!\mid$ ≤0·5). In contrast, pair-wise comparisons of percentile values between the pooled SEANUTS sample and WHO revealed large differences.

    CONCLUSIONS: The current study calculated length/height percentile values for South East Asian children aged 0·5-12 years and supported the appropriateness of using pooled SEANUTS length/height percentile values for assessing children's growth instead of country-specific ones. Pooled SEANUTS percentile values were found to differ from the WHO growth references and therefore this should be kept in mind when using WHO growth curves to assess length/height in these populations.

  11. Rahman M, Islam MJ, Haque SE, Saw YM, Haque MN, Duc NH, et al.
    Public Health Nutr, 2017 Feb;20(2):305-314.
    PMID: 27608854 DOI: 10.1017/S136898001600224X
    OBJECTIVE: To explore the association between high-risk fertility behaviours and the likelihood of chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women of reproductive age.

    DESIGN: The 2011 Bangladesh Demographic and Health Survey, conducted from 8 July to 27 December 2011.

    SETTING: Selected urban and rural areas of Bangladesh.

    SUBJECTS: A total of 2197 ever-married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of high-risk fertility behaviours. We considered three parameters, maternal age at the time of delivery, birth order and birth interval, to define the high-risk fertility behaviours. Chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women were the outcome variables.

    RESULTS: A substantial percentage of women were exposed to have a high-risk fertility pattern (41·8 %); 33·0 % were at single high-risk and 8·8 % were at multiple high-risk. After adjusting for relevant covariates, high-risk fertility behaviours were associated with increased likelihood of chronic undernutrition (adjusted relative risk; 95 % CI: 1·22; 1·03, 1·44), anaemia (1·12; 1·00, 1·25) and the coexistence of anaemia and undernutrition (1·52; 1·17, 1·98). Furthermore, multiple high-risk fertility behaviours appeared to have more profound consequences on the outcome measured.

    CONCLUSIONS: Maternal high-risk fertility behaviours are shockingly frequent practices among women in Bangladesh. High-risk fertility behaviours are important predictors of the increased likelihood of women's chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition.

  12. 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.

  13. Nurliyana AR, Mohd Nasir MT, Zalilah MS, Rohani A
    Public Health Nutr, 2015 Feb;18(2):303-12.
    PMID: 24507623 DOI: 10.1017/S1368980014000068
    OBJECTIVE: The present study aimed to identify dietary patterns and determine the relationship between dietary patterns and cognitive ability among 12- to 13 year-old Malay adolescents in the urban areas of Gombak district in Selangor, Malaysia.

    DESIGN: Data on sociodemographic background were obtained from parents. Height and weight were measured and BMI-for-age was determined. Adolescents were interviewed on their habitual dietary intakes using a semi-quantitative FFQ. Cognitive ability was assessed using the Wechsler Nonverbal Scale of Ability in a one-to-one manner. Dietary patterns were constructed using principal component analysis based on thirty-eight food groups of the semi-quantitative FFQ.

    SETTING: Urban secondary public schools in the district of Gombak in Selangor, Malaysia.

    SUBJECTS: Malay adolescents aged 12 to 13 years (n 416).

    RESULTS: The mean general cognitive ability score was 101·8 (sd 12·4). Four major dietary patterns were identified and labelled as 'refined-grain pattern', 'snack-food pattern', 'plant-based food pattern' and 'high-energy food pattern'. These dietary patterns explained 39·1 % of the variance in the habitual dietary intakes of the adolescents. The refined-grain pattern was negatively associated with processing speed, which is a construct of general cognitive ability. The high-energy food pattern was negatively associated with general cognitive ability, perceptual reasoning and processing speed. Monthly household income and parents' educational attainment were positively associated with all of the cognitive measures. In multivariate analysis, only the high-energy food pattern was found to contribute significantly towards general cognitive ability after controlling for socio-economic status.

    CONCLUSIONS: Consumption of foods in the high-energy food pattern contributed towards general cognitive ability after controlling for socio-economic status. However, the contribution was small.

  14. Noor MI
    Public Health Nutr, 2002 Feb;5(1A):191-5.
    PMID: 12027284
    The accelerated phase of industrialisation and urbanisation in recent decades has inevitably brought about changes in the lifestyle of Malaysians. Changes in dietary habits and sedentary lifestyles are known to be associated with changes in health and increased prevalence of chronic diseases in the population. The objective of this paper is to provide a better understanding of the link between demographic variables and food consumption patterns related to the nutrition transition in Malaysia. This review uses various reports and publications from several ministries and selected local studies. The statistics compiled over the last two decades have shown that as the population achieves affluence, intakes of calories, fats and sugars increase, which may account for the substantial increase in food importation bills over the same period. Similarly, the rapid growth of the fast food industry during the last decade has added another dimension to the change in food consumption patterns of Malaysians. With the exception of a study on adolescents, the prevalences of overweight and obesity in children and adults are not strictly comparable due to the difference in body mass index (BMI) cut-off points in children and the study protocol in adults, and hence should not be misinterpreted as trends. The recent recommendation to lower the BMI cut-off points for Asians would only increase the magnitude of the existing prevalence among adults. The need to promote healthy nutrition for the population must be pursued vigorously, as the escalation of nutrition-related chronic degenerative diseases - once an urban phenomenon--has now spread to the rural population at an alarming rate. This paper indicates that the problem is real and needs urgent attention because it may be just the tip of the iceberg.
  15. Ng S, Swinburn B, Kelly B, Vandevijvere S, Yeatman H, Ismail MN, et al.
    Public Health Nutr, 2018 Dec;21(18):3395-3406.
    PMID: 30277185 DOI: 10.1017/S1368980018002379
    OBJECTIVE: To determine the degree of food environment policies that have been implemented and supported by the Malaysian Government, in comparison to international best practice, and to establish prioritised recommendations for the government based on the identified implementation gaps.

    DESIGN: The Healthy Food-Environment Policy Index (Food-EPI) comprises forty-seven indicators of government policy practice. Local evidence of each indicator was compiled from government institutions and verified by related government stakeholders. The extent of implementation of the policies was rated by experts against international best practices. Rating results were used to identify and propose policy actions which were subsequently prioritised by the experts based on 'importance' and 'achievability' criteria. The policy actions with relatively higher 'achievability' and 'importance' were set as priority recommendations for government action.

    SETTING: Malaysia.

    SUBJECTS: Twenty-six local experts.

    RESULTS: Majority (62 %) of indicators was rated 'low' implementation with no indicator rated as either 'high' or 'very little, if any' in terms of implementation. The top five recommendations were (i) restrict unhealthy food marketing in children's settings and (ii) on broadcast media; (iii) mandatory nutrition labelling for added sugars; (iv) designation of priority research areas related to obesity prevention and diet-related non-communicable diseases; and (v) introduce energy labelling on menu boards for fast-food outlets.

    CONCLUSIONS: This first policy study conducted in Malaysia identified a number of gaps in implementation of key policies to promote healthy food environments, compared with international best practices. Study findings could strengthen civil society advocacies for government accountability to create a healthier food environment.

  16. Moy FM, Hoe VC, Hairi NN, Vethakkan SR, Bulgiba A
    Public Health Nutr, 2017 Jul;20(10):1844-1850.
    PMID: 27086558 DOI: 10.1017/S1368980016000811
    OBJECTIVE: To determine the association of vitamin D status with depression and health-related quality of life among women.

    DESIGN: This was a cross-sectional study conducted among women in Kuala Lumpur, Malaysia. Sociodemographic characteristics, physical activity status, perceived depression and health-related quality of life were assessed via a self-administered questionnaire. Fasting blood samples were taken for the analysis of 25-hydroxyvitamin D, parathyroid hormone, fasting blood glucose and full lipid profile. Complex samples multiple logistic regression analysis was performed.

    SETTING: Public secondary schools in Kuala Lumpur, Malaysia.

    SUBJECTS: Seven hundred and seventy female teachers were included.

    RESULTS: The mean age of participants was 41·15 (95 % CI 40·51, 41·78) years and the majority were ethnic Malays. Over 70 % of them had vitamin D deficiency (<20 ng/ml or <50 nmol/l) and two-thirds were at risk for depression. In the multivariate analysis, ethnic Malays (adjusted OR (aOR)=14·72; 95 % CI 2·12, 102·21) and Indians (aOR=14·02; 95 % CI 2·27, 86·59), those at risk for depression (aOR=1·88, 95 % CI 1·27, 2·79) and those with higher parathyroid hormone level (aOR=1·13; 95 % CI 1·01, 1·26) were associated with vitamin D deficiency, while vitamin D deficiency was negatively associated with mental health-related quality of life (Mental Component Summary) scores (aOR=0·98; 95 % CI 0·97, 0·99).

    CONCLUSIONS: Vitamin D deficiency is significantly associated with depression and mental health-related quality of life among women in Kuala Lumpur, Malaysia.

  17. Mohammadi S, Su TT, Papadaki A, Jalaludin MY, Dahlui M, Mohamed MNA, et al.
    Public Health Nutr, 2021 Jun;24(8):2273-2285.
    PMID: 32744217 DOI: 10.1017/S1368980020002293
    OBJECTIVE: To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents.

    DESIGN: A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data.

    SETTING: Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia.

    PARTICIPANTS: Focus groups were conducted with seventy-six adolescents aged 13-14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators.

    RESULTS: Stakeholders thought that adolescents' misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers' commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA.

    CONCLUSIONS: These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents.

  18. Mohamad MS, Mahadir Naidu B, Kaltiala R, Virtanen SM, Lehtinen-Jacks S
    Public Health Nutr, 2021 Dec;24(18):6309-6322.
    PMID: 34348828 DOI: 10.1017/S1368980021003190
    OBJECTIVE: To examine secular trends and sociodemographic determinants of thinness, overweight and obesity among Malaysian children and adolescents from 2006 to 2015.

    DESIGN: We used cross-sectional data from the National Health and Morbidity Surveys 2006, 2011 and 2015. Individuals were classified into pre- (6-9 years), early (10-13 years) and mid- (14-17 years) adolescence. BMI status was determined according to the International Obesity Task Force (IOTF) and WHO criteria, using measured height and weight. We analysed trends using log-binomial regression, by sex-age groups, stratified by sociodemographic factors (ethnicity, residential area, household size and household income), and accounting for the complex survey design. Associations between sociodemographic factors and prevalence of thinness and overweight (obesity included) in 2015 were assessed using log-Poisson regression.

    SETTING: Nationwide population-based surveys, Malaysia.

    PARTICIPANTS: Eligible 6-17-year-olds from urban and rural residential areas (n 28 094).

    RESULTS: The prevalence of thinness decreased from 2006 to 2015 (IOTF: boys from 22 % to 18 %, girls from 23 % to 19 %; WHO: boys from 9 % to 7 %, girls from 8 % to 6 %), while the prevalence of overweight increased (IOTF: boys from 20 % to 26 %, girls from 19 % to 24 %; WHO: boys from 25 % to 31 %, girls from 22 % to 27 %). These changes were statistically significant in most sex-age groups. Thinness and overweight co-existed in all sociodemographic subgroups, with variation in the prevalence estimates, but similar secular changes in most subgroups.

    CONCLUSIONS: Malaysia is facing a double burden of malnutrition at population level with a secular increase in overweight and obesity and a gradual decrease in thinness among 6-17-year-olds from varying sociodemographic backgrounds.

  19. McKenzie BL, Mustapha FI, Battumur BE, Batsaikhan E, Chandran A, Michael V, et al.
    Public Health Nutr, 2024 Feb 12;27(1):e89.
    PMID: 38343162 DOI: 10.1017/S1368980023002781
    OBJECTIVE: To understand the extent to which national salt reduction strategies in Malaysia and Mongolia were implemented and achieving their intended outcomes.

    DESIGN: Multiple methods process evaluations conducted at the mid-point of strategy implementation, guided by theoretical frameworks.

    SETTING: Malaysia (2018-2019) and Mongolia (2020-2021).

    PARTICIPANTS: Desk-based reviews of related documents, interviews with key stakeholders (n 12 Malaysia, n 10 Mongolia), focus group discussions with health professionals in Malaysia (n 43) and health provider surveys in Mongolia (n 12).

    RESULTS: Both countries generated high-quality local evidence about salt intake and levels in foods and culturally specific education resources. In Malaysia, education and reformulation activities were delivered with moderate dose (quantity) but reach among the population was low. Within 5 years, Mongolia implemented education among schools, health professionals and food producers on salt reduction with high reach, but with moderate dose (quantity) and reach among the general population. Both countries faced challenges in implementing legislative interventions (mandatory salt labelling and salt limits in packaged foods) and both could improve the scaling up of their reformulation and education activities.

    CONCLUSIONS: In the first half of Malaysia's and Mongolia's strategies, both countries generated necessary evidence and education materials, mobilised health professionals to deliver salt reduction education and achieved small-scale reformulation in foods. Both subsequently should focus on implementing regulatory policies and achieving population-wide reach and impact. Process evaluations of existing salt reduction strategies can help strengthen intervention delivery, aiding achievement of WHO's 30 % reduction in salt intake by 2025 target.

  20. Lipoeto NI, Geok Lin K, Angeles-Agdeppa I
    Public Health Nutr, 2013 Sep;16(9):1637-43.
    PMID: 23157893 DOI: 10.1017/S1368980012004569
    OBJECTIVE: The present study was done to confirm the relationship between changes in food patterns and nutrition transition in three South-East Asian countries, namely the Philippines, Malaysia and Indonesia.

    DESIGN: This was a cross-sectional study conducted between August 2008 and August 2009 using three methods: interviews, focus group discussions and analyses of government reports.

    SETTING: The study was conducted in rural and urban areas in Manila and Calabanga (Philippines), Selangor and Kuala Selangor (Malaysia), and Padang, Pariaman Tanah Datar and Limapuluh Kota (West Sumatra, Indonesia).

    SUBJECTS: Adults aged 18 to 77 years.

    RESULTS: The results showed that Filipinos, Malaysians and Indonesians have retained many aspects of their traditional diets. In fact, most participants in the study considered Western-style and franchise fast foods as snack or recreational foods to be consumed once in a while only. However, a significant difference was noted between urban and rural areas in food varieties consumed. Participants in urban areas consumed more varieties of traditional foods owing to their availability and the participants’ food purchasing power. Although traditional food patterns were maintained by most of the participants, more sugar and vegetable oils were consumed and added to the traditional recipes.

    CONCLUSIONS: The rapid nutrition transition in this region may be due, instead, to increasing food availability and food purchasing power, rather than to a shift in food preferences towards modern Western foods.

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