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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.
Determinants of linear growth in Malaysian children with cerebral palsy

Zainah SH, Ong LC, Sofiah A, Poh BK, Hussain IH

J Paediatr Child Health, 2001 Aug;37(4):376-81.
PMID: 11532058

OBJECTIVE: To compare the linear growth and nutritional parameters of a group of Malaysian children with cerebral palsy (CP) against a group of controls, and to determine the nutritional, medical and sociodemographic factors associated with poor growth in children with CP.
METHODOLOGY: The linear growth of 101 children with CP and of their healthy controls matched for age, sex and ethnicity was measured using upper-arm length (UAL). Nutritional parameters of weight, triceps skin-fold thickness and mid-arm circumference were also measured. Total caloric intake was assessed using a 24-h recall of a 3-day food intake and calculated as a percentage of the Recommended Daily Allowance. Multiple regression analysis was used to determine nutritional, medical and sociodemographic factors associated with poor growth (using z-scores of UAL) in children with CP.
RESULTS: Compared with the controls, children with CP had significantly lower mean UAL measurements (difference between means -1.1, 95% confidence interval -1.65 to - 0.59), weight (difference between means -6.0, 95% CI -7.66 to -4.34), mid-arm circumference (difference between means -1.3, 95% CI -2.06 to -0.56) and triceps skin-fold thickness (difference between means -2.5, 95% CI -3.5 to -1.43). Factors associated with low z-scores of UAL were a lower percentage of median weight (P < 0.001), tube feeding (P < 0.001) and increasing age (P < 0.001).
CONCLUSION: A large proportion of Malaysian children with CP have poor nutritional status and linear growth. Nutritional assessment and management at an early age might help this group of children achieve adequate growth.
Fulltext Association between Compliance with Movement Behavior Guidelines and Obesity among Malaysian Preschoolers

Lee ST, Wong JE, Chan GKL, Poh BK

Int J Environ Res Public Health, 2021 04 27;18(9).
PMID: 33925298 DOI: 10.3390/ijerph18094611

A daily balance of physical activities, sedentary behaviors and sleep are important for maintaining the health of young children. The aim of this study is to explore the association between 24-h movement behavior of Malaysian children aged 4 to 6 years with weight status. A total of 230 preschoolers were recruited from 22 kindergartens in Kuala Lumpur. Physical activity was assessed by Actical accelerometer while screen time and sleep duration were proxy-reported by parents. Children spent on average 5.5 ± 1.3 h on total physical activity (including 1.0 ± 0.4 h of moderate- vigorous physical activity), 3.0 ± 1.6 h on screen activities and 9.5 ± 1.3 h sleeping daily. The proportion of children who complied with physical activity and sleep guidelines were 48.7% and 55.2%, respectively. About 25.2% of children met screen time recommendation. Only 6.5% of children met all three age-specific physical activity, screen time and sleep guidelines. Children who met any two guidelines were less likely to be overweight or obesity compared to those who did not meet any of the guidelines (OR: 0.276; 95% CI: 0.080-0.950). In conclusion, Malaysian preschoolers have low compliance to movement behavior guidelines, especially in meeting screen time recommendations. Compliance to movement behavior guidelines was associated with lower odds of overweight and obesity.
Fulltext The female athlete triad among elite Malaysian athletes: prevalence and associated factors

Quah YV, Poh BK, Ng LO, Noor MI

Asia Pac J Clin Nutr, 2009;18(2):200-8.
PMID: 19713179

Women participating in a wide range of competitive sports are at higher risk of developing eating disorders, menstrual irregularities and osteoporosis, which are generally referred to as the 'female athlete triad'. The objective of this study was to determine the prevalence of female athlete triad and factors associated with this condition among athletes participating in different sports. A total of 67 elite female athletes aged between 13-30 years participated in the study and were subdivided into the 'leanness' and 'non-leanness' groups. Eating disorders were assessed using a body image figure rating and the Eating Disorder Inventory (EDI) with body dissatisfaction (BD), drive for thinness (DT), bulimia (B) and perfectionism (P) subscales. Menstrual irregularity was assessed with a self-reported menstrual history questionnaire. Bone quality was measured using a quantitative ultrasound device at one-third distal radius. Prevalence of the female athlete triad was low (1.9%), but the prevalence for individual triad component was high, especially in the leanness group. The prevalence of subjects who were at risk of menstrual irregularity, poor bone quality and eating disorders were 47.6%, 13.3% and 89.2%, respectively, in the leanness group; and 14.3%, 8.3% and 89.2%, respectively, in the non-leanness group. Since the components of the triad are interrelated, identification of athletes at risk of having any one component of the triad, especially those participating in sports that emphasise a lean physique, is an important aid for further diagnosis.
Fulltext Factors associated with poor academic achievement among urban primary school children in Malaysia

Ong LC, Chandran V, Lim YY, Chen AH, Poh BK

Singapore Med J, 2010 Mar;51(3):247-52.
PMID: 20428748

The aim of this study was to identify factors associated with poor academic achievement during the early school years.
Fulltext Factors Influencing Acceptance of Grasshoppers and Other Insects as Food: A Comparison between Two Cities in Malaysia

Lim SM, Thien CN, Toure AK, Poh BK

Foods, 2022 Oct 20;11(20).
PMID: 37431031 DOI: 10.3390/foods11203284

Entomophagy has recently sparked widespread attention worldwide. Although entomophagy is not a foreign dietary practice in Malaysia, acceptance of insects as food among Malaysians is still unclear. This study aimed to determine the acceptance of insects as food and its influencing factors among adults living in Klang Valley (Peninsular Malaysia) and Kuching, Sarawak (East Malaysia). A cross-sectional survey was conducted involving 292 adults from Klang Valley (n = 144) and Kuching (n = 148). Data was collected through self-administrated online questionnaires. Although most respondents (96.7%) had prior knowledge of people eating insects, only 30.1% of respondents accepted insects as food, and only 18.2% reported that they would be willing to include insects in their daily diet. There was no statistically significant difference in acceptance rates between Klang Valley and Kuching. The main factors influencing respondents' acceptance of insects as food were insect texture, food safety issues and aversion toward insects. In conclusion, the acceptance of insects as food among adults in Klang Valley and Kuching is still low, with sensory characteristics, food safety and sentiments of distaste being the main barriers. Future studies involving insect tasting and in-depth focus group discussion are needed for deeper insights into the acceptance of insects as food.
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.
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
Nutritional status and dietary intake of children with acute leukaemia during induction or consolidation chemotherapy

Tan SY, Poh BK, Nadrah MH, Jannah NA, Rahman J, Ismail MN

J Hum Nutr Diet, 2013 Jul;26 Suppl 1:23-33.
PMID: 23701375 DOI: 10.1111/jhn.12074

The assessment of nutritional status among paediatric patients is important for the planning and execution of nutritional strategies that strive to optimise the quality of life and growth among sick children. The present study aimed to evaluate the nutritional status and dietary intake among children with acute leukaemia.
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 Risk of metabolic syndrome among children living in metropolitan Kuala Lumpur: a case control study

Wee BS, Poh BK, Bulgiba A, Ismail MN, Ruzita AT, Hills AP

BMC Public Health, 2011;11:333.
PMID: 21592367 DOI: 10.1186/1471-2458-11-333

With the increasing prevalence of childhood obesity, the metabolic syndrome has been studied among children in many countries but not in Malaysia. Hence, this study aimed to compare metabolic risk factors between overweight/obese and normal weight children and to determine the influence of gender and ethnicity on the metabolic syndrome among school children aged 9-12 years in Kuala Lumpur and its metropolitan suburbs.
Fulltext High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia

Khor GL, Chee WS, Shariff ZM, Poh BK, Arumugam M, Rahman JA, et al.

BMC Public Health, 2011;11:95.
PMID: 21310082 DOI: 10.1186/1471-2458-11-95

Deficiencies of micronutrients can affect the growth and development of children. There is increasing evidence of vitamin D deficiency world-wide resulting in nutritional rickets in children and osteoporosis in adulthood. Data on the micronutrient status of children in Malaysia is limited. The aim of this study was to determine the anthropometric and micronutrient status of primary school children in the capital city of Kuala Lumpur.
Plasma vitamin C and tocotrienols changes in response to dietary supplementation among young male adults

Zahara AM, Lee CC, Fatimah IS, Poh BK, Khairul O, Das S, et al.

Clin Ter, 2010;161(2):121-4.
PMID: 20499024

Intake of the antioxidant vitamins C and E lowers the oxidative stress. The study aimed to determine plasma concentrations of vitamin C and tocotrienols after supplementation of both vitamins in young male adults.
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.
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.
Malnutrition in early life and its neurodevelopmental and cognitive consequences: a scoping review

Suryawan A, Jalaludin MY, Poh BK, Sanusi R, Tan VMH, Geurts JM, et al.

Nutr Res Rev, 2021 Jun 08.
PMID: 34100353 DOI: 10.1017/S0954422421000159

The negative impact of stunting and severe underweight on cognitive neurodevelopment of children is well documented; however, the effect of overweight/obesity is still unclear. The 2018 Global Nutrition Report reported that stunting and overweight concurrently affect 189 million children worldwide. As existing reviews discuss undernutrition and overweight/obesity separately, this scoping review aims to document the impact of mild/moderate and severe underweight, stunting, and overweight/obesity among children aged 0-60 months on their cognitive neurodevelopmental trajectories. Twenty-six articles were analysed to extract significant information from literature retrieved from PubMed and Cochrane databases published from 1 January 2009 to 31 October 2019. Length gain is associated with cognitive neurodevelopment in normo-nourished and stunted children aged under 24 months. Among stunted children, it seems that cognitive and neurodevelopmental deficits can potentially be recovered before 8 years of age, particularly in those whose nutritional status has improved. The impact of overweight/obesity on cognitive neurodevelopment appears to be limited to attention, gross motor skills and executive control. Parental education level, birth weight/length, breastfeeding duration, and sanitation level are some identifiable factors that modify the impact of undernutrition and overweight/obesity on cognitive and neurodevelopment. In conclusion, underweight, stunting and overweight/obesity have a significant impact on cognitive neurodevelopment. Multidimensional approaches with various stakeholders should address all issues simultaneously, such as improving sanitation levels, assuring parental job security and adequate social welfare, and providing access to adequate nutrients for catch-up growth among underweight or stunted children and to affordable healthy foods for those who are overweight/obese and from low socio-economic status.

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