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Fulltext Daily physical activity and screen time, but not other sedentary activities, are associated with measures of obesity during childhood

Lee ST, Wong JE, Shanita SN, Ismail MN, Deurenberg P, Poh BK

Int J Environ Res Public Health, 2015 Jan;12(1):146-61.
PMID: 25546277 DOI: 10.3390/ijerph120100146

Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body mass index (BMI), BMI-for-age Z-score (BAZ), body fatness (%BF) and waist circumference (WC). A total of 1736 children, representing all ethnic groups were recruited from six regions of Malaysia. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance. Physical activity was assessed by a physical activity questionnaire (PAQ) in all children and by pedometers in a subsample (n = 514). PAQ score and pedometer step counts were negatively associated with BMI, BAZ, %BF and WC after adjusting for covariates. Screen time was positively associated with BAZ and WC. However, other sedentary activities were not significantly related with any anthropometric indicators. Strategies to promote active living among children in Malaysia should focus not only on increasing physical activity but also emphasise reduction in sedentary behaviours.
MESH: screen time
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 Erratum to "Radial Quantitative Ultrasound and Dual Energy X-Ray Absorptiometry: Intermethod Agreement for Bone Status Assessment in Children"

Chong KH, Poh BK, Jamil NA, Kamaruddin NA, Deurenberg P

Biomed Res Int, 2015;2015:318739.
PMID: 26146617 DOI: 10.1155/2015/318739
Fulltext Radial quantitative ultrasound and dual energy x-ray absorptiometry: intermethod agreement for bone status assessment in children

Chong KH, Poh BK, Jamil NA, Kamaruddin NA, Deurenberg P

Biomed Res Int, 2015;2015:232876.
PMID: 25922831 DOI: 10.1155/2015/232876

Aim. To validate a radial quantitative ultrasound (QUS) system with dual energy X-ray absorptiometry (DXA), a criterion technique in bone status assessment among children. Methods. Bone health was evaluated using a radial QUS system (Sunlight Omnisense 8000P) to measure the speed of sound (SOS) at one-third distal radius of the nondominant hand and DXA (Hologic QDR) was used to assess whole body bone mineral density (BMD). Results. Some 29.9% of the children were grossly misclassified according to quartiles of BMD and radial SOS. Poor agreement was observed between Z-scores of radial SOS and whole-body BMD (mean difference = 0.6 ± 0.9; 95% limits of agreement = -1.4 to 2.6). With a cut-off value of -1.0, radial SOS yielded satisfactory sensitivity (80%) and specificity (93%) for the detection of children with low BMD. Conclusion. The observed poor agreement in the present study suggests that radial QUS and DXA are not comparable and hence are not interchangeable in evaluating bone status of the children.
Fulltext Reliability and validity of Malay language version of International Physical Activity Questionnaire (IPAQ-M) among the Malaysian cohort participants

Shamsuddin N, Poh BK, Syed Zakaria SZ, Noor MI, Jamal R

Int J Public Health Res, 2015;5(2):643-653.
MyJurnal

Introduction: Validation of instruments is essential when assessing physical activity (PA). The aim of this study was to validate a Malay language version of the International Physical Activity Questionnaire (IPAQ-M) against Actical accelerometer and to determine its reliability and validity.
Methods: A total of 90 Malay adults aged 35-65 years old participating in The Malaysian Cohort project were recruited for this study. The IPAQ-M is comprised of 12 items, covering vigorous, moderate, walking, sitting and sleeping activities, and was administered on two occasions (Day 1 and Day 9) by interviewing the participants. Participants wore the Actical accelerometer for seven consecutive days between the two interview sessions. Results Validity tests showed that time spent in moderate-vigorous physical activity (MVPA) (min/wk) from IPAQ-M was significantly correlated with MVPA from accelerometer (rho=0.32, p<0.01). Time spent in vigorous activity (rho=0.44) and total activity (rho=0.36) from IPAQ-M were significantly correlated (p<0.01) with that measured by accelerometer, but no correlation was observed for sedentary behaviour. Reliability tests revealed significant correlations between the two interview sessions for all intensities of PA (rho=0.55 to 0.71, p<0.01). Bland-Altman plots showed that time spent in MVPA for IPAQ-M was significantly different from that measured by accelerometer (mean difference: 98.02 min/wk; 95% limits of agreement: -785.33 to 1317.83 min/wk; p<0.01). When classifying people into meeting PA recommendation, the agreement between the two instruments was fair (κ=0.22).
Conclusions The IPAQ-M has acceptable validity for MVPA, vigorous and total physical activity, and was reliable for assessing the physical activity of Malay adults.
Keywords Health care workers - Knowledge - Practice - Universal precaution - Health center.
Study name: The Malaysian Cohort (TMC) Project
Fulltext Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years

Xi B, Zong X, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, et al.

Circulation, 2016 Jan 26;133(4):398-408.
PMID: 26671979 DOI: 10.1161/CIRCULATIONAHA.115.017936

Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States).
Differences in Body Build in Children of Different Ethnic Groups and their Impact on the Prevalence of Stunting, Thinness, Overweight, and Obesity

Poh BK, Wong JE, Norimah AK, Deurenberg P

Food Nutr Bull, 2016 Mar;37(1):3-13.
PMID: 26769039 DOI: 10.1177/0379572115626025

The prevalence of stunting, thinness, overweight, and obesity among children differs by ethnicity. It is not known whether differences in body build across the ethnic groups influence the interpretation of nutritional parameters.
Sensitivity And Specificity Of WHO-BMI Criteria For Obesity Of Asian Youth: The Asia-fit Study: 615 Board #5 June 1, 1: 00 PM - 3: 00 PM

Sai-Chuen Hui S, Suzuki K, Naito H, Balasekaran G, Song JK, Park SY, et al.

Med Sci Sports Exerc, 2016 May;48(5 Suppl 1):159.
PMID: 27584229 DOI: 10.1249/01.mss.0000485478.41107.7a
Association of Eating Behavior With Nutritional Status and Body Composition in Primary School-Aged Children

Tay CW, Chin YS, Lee ST, Khouw I, Poh BK, SEANUTS Malaysia Study Group

Asia Pac J Public Health, 2016 07;28(5 Suppl):47S-58S.
PMID: 27252248 DOI: 10.1177/1010539516651475

Problematic eating behaviors during childhood may lead to positive energy balance and obesity. Therefore, this study aims to investigate the association of eating behaviors with nutritional status and body composition in Malaysian children aged 7 to 12 years. A total of 1782 primary schoolchildren were randomly recruited from 6 regions in Malaysia. The multidimensional Children's Eating Behaviour Questionnaire (CEBQ) was reported by parents to determine the 8 different dimensions of eating styles among children. Body mass index (BMI), BMI-for-age Z-score, waist circumference, and body fat percentage were assessed. Linear regression analyses revealed that both food responsiveness and desire to drink subscales were positively associated with a child's body adiposity, whereas satiety responsiveness, slowness in eating, and emotional undereating subscales were negatively associated with adiposity (all P < .05). A multidimensional eating style approach based on the CEBQ is needed to promote healthy eating behaviors in order to prevent excessive weight gain and obesity problems among Malaysian children.
Assessing Body Fat of Children by Skinfold Thickness, Bioelectrical Impedance Analysis, and Dual-Energy X-Ray Absorptiometry: A Validation Study Among Malay Children Aged 7 to 11 Years

Noradilah MJ, Ang YN, Kamaruddin NA, Deurenberg P, Ismail MN, Poh BK

Asia Pac J Public Health, 2016 Jul;28(5 Suppl):74S-84S.
PMID: 27073201 DOI: 10.1177/1010539516641505

This study aims to validate skinfold (SKF) and bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) in determining body fat percentage (BF%) of Malay children aged 7 to 11 years. A total of 160 children had their BF% assessed using SKF and BIA, with DXA as the criterion method. Four SKF equations (SKFBray, SKFJohnston, SKFSlaughter, and SKFGoran) and 4 BIA equations (BIAManufacturer, BIAHoutkooper, BIARush, and BIAKushner) were used to estimate BF%. Mean age, weight, and height were 9.4 ± 1.1years, 30.5 ± 9.9 kg, and 131.3 ± 8.4 cm. All equations significantly underestimated BF% (P < .05). BIA equations had reasonable agreement with DXA and were independent of BF% with BIAManufacturer being the best equation. Although BIA underestimates BF% as compared with DXA, BIA was more suitable to measure BF% in a population that is similar to this study sample than SKF, suggesting a need to develop new SKF equations that are population specific.
Are Malaysian Children Achieving Dietary Guideline Recommendations?

Koo HC, Poh BK, Lee ST, Chong KH, Bragt MC, Abd Talib R, et al.

Asia Pac J Public Health, 2016 07;28(5 Suppl):8S-20S.
PMID: 27073200 DOI: 10.1177/1010539516641504

A large body of epidemiological data has demonstrated that diet quality follows a sociodemographic gradient. Little is known, however, about food group intake patterns among Malaysian children. This study aimed to assess consumption pattern of 7 food groups, including cereals/grains, legumes, fruits, vegetables, fish, meat/poultry, and milk/dairy products, among children 7 to 12 years of age. A total of 1773 children who participated in SEANUTS Malaysia and who completed the Food Frequency Questionnaire were included in this study. A greater proportion of children aged 10 to 12 years have an inadequate intake of cereals/grains, meat/poultry, legumes, and milk/dairy products compared with children 7 to 9 years old. With the exception of meat/poultry, food consumption of Malaysian children did not meet Malaysian Dietary Guidelines recommendations for the other 6 food groups, irrespective of sociodemographic backgrounds. Efforts are needed to promote healthy and balanced dietary habits, particularly for foods that fall short of recommended intake level.
Physical activity pattern of Malaysian preschoolers: Environment, barriers, and motivators for active play

Lee ST, Wong JE, Ong WW, Ismail MN, Deurenberg P, Poh BK

Asia Pac J Public Health, 2016 07;28(5 Suppl):21S-34S.
PMID: 27026634 DOI: 10.1177/1010539516638155

Children's physical activity has been correlated with child characteristics and social or physical environment. This study aimed to compare preschoolers' physical activity among various sociodemographic characteristics and to determine barriers, motivators, and environmental factors for active play. A total of 835 preschoolers were included in this analysis. Time spent on active play, quiet play, and screen time was reported by parents. Boys spent significantly more time on active play and screen time than girls. Time spent on quiet play was highest in East Coast Peninsular Malaysia and lowest in Sarawak. Some 40% of children achieved active play recommendation while 27% exceeded daily screen time recommendation. Most parents reported that their child played actively in the house area; and that the main barrier and motivator to active play were safety and child's enjoyment, respectively. These findings demonstrate that sociodemographic characteristics and environment should be considered in designing physical activity intervention programs.
MESH: screen time
Eating Habits of Malaysian Children: Findings of the South East Asian Nutrition Surveys (SEANUTS)

Chong KH, Wu SK, Noor Hafizah Y, Bragt MC, Poh BK, SEANUTS Malaysia Study Group

Asia Pac J Public Health, 2016 07;28(5 Suppl):59S-73S.
PMID: 27307424 DOI: 10.1177/1010539516654260

This article aims to describe the eating habits of Malaysian children using a nationally representative data set from the South East Asian Nutrition Surveys (SEANUTS) in Malaysia. A total of 2797 children aged 2 to 12 years were included in this analysis. Eating habits and dietary intakes of children were assessed using questionnaires. Overall, 56.1% of children consumed 3 main meals every day. Approximately 20% of children snacked 3 times per day, whereas 9.7% ate fast food on a weekly basis. Irregular meal patterns were significantly associated with lower micronutrient intakes, and the groups with higher odds for this pattern were older children, Malays, and those living in rural areas. Considering the relatively high rate of irregular meal consumption and its potential influence on dietary nutrient intake, persistent efforts must be continued to promote and inculcate healthy eating habits among children from an early age.
Physical Activity of Malaysian Primary School Children: Comparison by Sociodemographic Variables and Activity Domains

Wong JE, Parikh P, Poh BK, Deurenberg P, SEANUTS Malaysia Study Group

Asia Pac J Public Health, 2016 Jul;28(5 Suppl):35S-46S.
PMID: 27257293 DOI: 10.1177/1010539516650726

This study describes the physical activity of primary school children according to sociodemographic characteristics and activity domains. Using the Malaysian South East Asian Nutrition Surveys data, 1702 children aged 7 to 12 years were included in the analysis. Physical activity was reported as a total score and categorized into low, medium, and high levels based on Physical Activity Questionnaire for Older Children. Higher overall activity scores were found in boys, younger age, non-Chinese ethnicity, and normal body mass index category. Sex, age, and ethnicity differences were found in structured or organized, physical education, and outside-of-school domain scores. Transport-related scores differed by age group, ethnicity, household income, and residential areas but not among the three physical activity levels. Participation of girls, Chinese, and older children were low in overall and almost all activity domains. Sociodemographic characteristics are important factors to consider in increasing the different domains of physical activity among Malaysian children.
Length and height percentiles for children in the South-East Asian Nutrition Surveys (SEANUTS)

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.
Fulltext Vitamin D deficiency and its risk factors in Malaysian children with epilepsy

Fong CY, Kong AN, Poh BK, Mohamed AR, Khoo TB, Ng RL, et al.

Epilepsia, 2016 08;57(8):1271-9.
PMID: 27378185 DOI: 10.1111/epi.13443

OBJECTIVE: Long-term use of antiepileptic drugs (AEDs) is a significant risk factor for vitamin D deficiency in children with epilepsy. The aims of our study were to evaluate the prevalence and risk factors for vitamin D deficiency among Malaysian children with epilepsy.
METHODS: Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in three tertiary hospitals in Malaysia from April 2014 to April 2015. Detailed assessment of pubertal status, skin pigmentation, sunshine exposure behavior, physical activity, dietary vitamin D and calcium intake, anthropometric measurements and bone health blood tests (vitamin D, alkaline phosphatase, calcium, phosphate, and parathyroid hormone levels) were obtained on all patients. Vitamin D deficiency was defined as 25-hydroxy vitamin D [25(OH)D] levels ≤35 nmol/L and insufficiency as 25(OH)D levels of 36-50 nmol/L.
RESULTS: A total of 244 children (146 male) participated in the study. Ages ranged between 3.7 and 18.8 years (mean 12.3 years). 25(OH)D levels ranged between 7.5 and 140.9 nmol/L (mean 53.9 nmol/L). Vitamin D deficiency was identified in 55 patients (22.5%), and a further 48 (19.7%) had vitamin D insufficiency. Multivariate logistic regression analysis identified polytherapy >1 AED (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.07-4.36), age >12 years (OR 4.16, 95% CI 1.13-15.30), Indian ethnicity (OR 6.97, 95% CI 2.48-19.55), sun exposure time 30-60 min/day (OR 2.44, 95% CI 1.05-5.67), sun exposure time <30 min/day (OR 3.83, 95% CI 1.61-9.09), and female (OR 2.61, 95% CI 1.31-5.20) as statistically significant (p < 0.05) risk factors for vitamin D deficiency.
SIGNIFICANCE: Despite living in the tropics, a high proportion of Malaysian children with epilepsy are at risk of vitamin D deficiency. Targeted strategies including vitamin D supplementation and lifestyle advice of healthy sunlight exposure behavior should be implemented among children with epilepsy, particularly for those at high risk of having vitamin D deficiency.
Results from Malaysia's 2016 report card on physical activity for children and adolescents

Sharif R, Chong KH, Zakaria NH, Ong ML, Reilly JJ, Wong JE, et al.

J Phys Act Health, 2016 11;13(11 Suppl 2):S201-S205.
PMID: 27848721 DOI: 10.1123/jpah.2016-0404

BACKGROUND: The 2016 Malaysia Active Healthy Kids Report Card aims to collect, assess, and grade current and comprehensive data on physical activity (PA) and associated factors in Malaysian children and adolescents aged 5 to 17 years.
METHODS: This report card was developed following the Active Healthy Kids Canada Report Card protocol. The Research Working Group identified the core matrices, assessed the key data sources, and evaluated the evidence gathered for grade assignments. A grade was assigned to each indicator by comparing the best available evidence against relevant benchmark using a standardized grading scheme.
RESULTS: Overall Physical Activity, Active Transportation, and Sedentary Behavior were assigned the D grade. The lowest grade of F was assigned to Diet, while School and Government Strategies and Investments were graded higher with a B. Five indicators were assigned INC (incomplete) due to a lack of representative data.
CONCLUSIONS: The report card demonstrates that Malaysian children and adolescents are engaging in low levels of PA and active commuting, high levels of screen time, and have extremely low compliance with dietary recommendations. More efforts are needed to address the root causes of physical inactivity while increasing the opportunities for children and adolescents to be more physically active.
MESH: screen time
Fulltext Association between polymorphisms of insulin and insulin receptor gene with childhood obesity in malay population

Christinal Teh Pey Wen, Nurul Adibah Nizam, Abdul Rahman Jamal, Wan Zurinah Wan Ngah, Chong, Pei Nee, Poh, Bee Koon

Jurnal Sains Kesihatan Malaysia, 2016;14(1):5-9.
MyJurnal

Childhood obesity is a global epidemic, which leads to the increasing number of studies on genetic locations associated with obesity-related traits. Polymorphisms of insulin (INS) gene have been shown to be associated with obesity-related phenotypes in Europeans; while insulin receptor (INSR) gene has been associated with energy regulation. Therefore, this study was conducted to investigate the association between the INS (rs689) and INSR (rs3745551) gene polymorphisms with childhood obesity risk in a Malay childhood population. Normal weight (538) and overweight or obese (557) children aged 6-12 years old were genotyped using semi-automated Sequenom iPLEX® Gold. Body mass index (BMI) was calculated from measured body weight and height. The rs689 (T/T: 0.006, A/T: 0.159 and A/A: 0.835) and rs3745551 (G/G: 0.054, A/G: 0.378 and A/A: 0.568) genotype distributions were consistent with Hardy Weinberg equilibrium. The T-minor allele frequency for rs689 was 8.6% and G-minor allele frequency for rs3745551 was 24.3%. Minor allele of INS gene polymorphisms significantly increased risk of obesity among Malay children (sex- and age-adjusted
OR=1.580; 95%CI: 1.134-2.201). However, INSR gene polymorphisms were not significantly associated with childhood obesity. In conclusion, the polymorphisms of INS gene, rather than INSR gene, were associated with childhood obesity in the Malay population.
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.
Fulltext Can Malaysian Young Adults Report Dietary Intake Using a Food Diary Mobile Application? A Pilot Study on Acceptability and Compliance

Chen YS, Wong JE, Ayob AF, Othman NE, Poh BK

Nutrients, 2017 Jan 13;9(1).
PMID: 28098770 DOI: 10.3390/nu9010062

Mobile applications may improve dietary reporting among young adults due to their high accessibility and embedded camera function. This pilot study aimed to (i) evaluate users' acceptability and compliance in reporting dietary intake using a newly developed food diary mobile application (food app); and (ii) identify issues and recommendations for improving dietary assessment using this food app via quantitative and qualitative protocols. Twenty-eight university students each used a food app for seven consecutive days and attended one of five focus group interviews. A 42% decrement in reporting compliance was observed throughout the seven-day recording period. An average of 5.9 recording days were reported and 4.8 occasions of meal data were uploaded each day. Based on questionnaires, high levels of agreement were reported in terms of perceived usefulness (69.3%), perceived ease of use (77.1%), attitude (73.6%), perceived enjoyment (62.6%), and smartphone experience (91.1%), but such agreement was not reported for intention to use (38.1%) and social influence (33.4%). Four major themes emerged from the focus group interviews, namely, (i) features; (ii) potential use; (iii) utility issues of the food app; and (iv) suggestions for improvements. While the food app was well-accepted by most of the young adults, the current prototype would benefit from incorporation of a barcode scanning function, customizable reminders, in-app tutorial, an entertainment component, and enhancement in overall appearance.

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