Displaying publications 21 - 40 of 51 in total

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  1. Lim SY, Dora R, Yatiman NH, Wong JE, Haron H, Poh BK
    Appetite, 2021 12 01;167:105629.
    PMID: 34364967 DOI: 10.1016/j.appet.2021.105629
    Studies have shown that monosodium glutamate (MSG) can enhance satiety and reduce appetite among infants and adults. In a multi-ethnic country such as Malaysia, it is also important to consider whether ethnic variations will influence the effects of MSG on appetite regulation. Thus, this crossover study aimed to investigate the effects of MSG on the subjective appetite and subsequent energy intake among Malaysian children from the three major ethnic groups, namely the Malays, Chinese and Indians. A total of 92 participants aged 9-11 years from the three ethnic groups were recruited for this study. A cup of low-energy vegetable preload soup (100g, with MSG or without MSG) was served to each of the participants on the day of the study, followed by an ad libitum meal 45 min later. Appetite ratings of hunger, fullness, desire to eat and desire to snack were recorded using visual analogue scale (VAS) before the preload, after the preload, before the ad libitum meal and after the ad libitum meal. Results showed that the subjective appetite of the children did not differ between preload conditions (MSG+ or MSG-) throughout the study. Malay, Chinese and Indian children had similar total energy intake during the subsequent meal after the consumption of preload soups. In conclusion, the addition of MSG to low energy preload neither influenced the perception of appetite nor total energy intake in a subsequent ad libitum meal among children. No difference attributable to the participants' ethnicity was observed. Future studies should be conducted to examine whether repeated ingestion of MSG-containing protein-rich preload has potential longer-term effects on appetite and subsequent meal intakes among children from different ethnicities.
  2. Lim SY, Rosmawati D, Yatiman NH, Wong JE, Haron H, Poh BK
    Curr Res Food Sci, 2022;5:2204-2210.
    PMID: 36387604 DOI: 10.1016/j.crfs.2022.11.006
    Sensitivity to savory taste has been linked to high consumption of savory foods and increased risks of obesity and hypertension. However, there are limited studies that investigate whether obesity indices are correlated with the differences in umami taste perception, particularly in children. This study aimed to investigate the umami detection threshold among children of different ethnicities and the threshold's correlation with obesity indices and blood pressure. A total of 140 subjects were recruited and consisted of a nearly equal distribution of children from three main ethnicities (37.2% Malays, 31.4% Chinese, 31.4% Indians). Umami detection threshold was measured using the two-alternative, forced-choice staircase procedure. Body weight, height, waist circumference and blood pressure of children were measured. Body composition was assessed using bioelectrical impedance analysis (BIA). Mean umami detection threshold was 1.22 ± 1.04 mM and there were no observable differences attributable to the subjects' ethnicities. Body fat percentage was negatively correlated (r = -0.171, p 
  3. Shahril MR, Unal TI, Wong JE, Sharif R, Koh D, Lee ST, et al.
    J Exerc Sci Fit, 2023 Jan;21(1):88-94.
    PMID: 36447627 DOI: 10.1016/j.jesf.2022.11.001
    BACKGROUND: The Malaysia 2022 Report Card on Physical Activity for Children and Adolescents provides evidence-based assessment across 12 indicators of physical activity-related behaviors, individual characteristics, settings and sources of influence, and strategies and investments for children and adolescents.

    METHODS: The development process follows the systematic steps recommended by the Active Healthy Kids Global Alliance was used. Nationally representative data from 2016 to 2021, government reports and unpublished data were reviewed and consolidated by a panel of experts. Letter grades were assigned based on predefined benchmarks to 12 indicators including 10 core physical activity indicators that are common to Global Matrix 4.0 and two additional indicators (Diet and Weight Status). The current grading was then compared against those obtained in 2016.

    RESULTS: Four of six indicators in the Daily Behaviors category received D- or C grades [Overall Physical Activity, Active Transportation and Diet (D-); Sedentary Behaviors (C)], which remains poor, similar to the 2016 report card. School indicator was graded for the Settings and Sources of Influence category, which showed an improvement from grade B (2016) to A- (2022). As for the Strategies and Investments category, B was again assigned to the Government indicator. Two new indicators were added after the 2016 Report Card, and they were graded B (Physical Fitness) and B- (Weight Status). Four indicators (Organized Sports and Physical Activity, Active Play, Family and Peers, and Community and Environment) were again graded Incomplete due to a lack of nationally representative data.

    CONCLUSION: The 2022 Report Card revealed that Malaysian children and adolescents are still caught in the "inactivity epidemic". This warrants more engagement from all stakeholders, public health actions, and timely research, to comprehensively evaluate all indicators and drive a cultural shift to see Malaysian children and adolescents moving more every day.

  4. Lim SM, Goh YX, Wong JE, Kagawa M, Poh BK
    Percept Mot Skills, 2024 Apr;131(2):381-396.
    PMID: 38150555 DOI: 10.1177/00315125231225022
    The Food Neophobia Scale (FNS) is a research instrument, originally developed in English, to assess an individual's level of food neophobia. However, it has not yet been translated and validated for Malaysians. Therefore, we aimed to translate and validate a Malay-translated version of the FNS. Respondents were 200 young adults (mostly females, 73%; and students, 82.0%; M age = 22.3 years, SD = 2.3). We first translated the FNS into Malay using the forward-backward translation method, and a panel of nutrition and dietetics experts then reviewed it for item relevance, clarity, simplicity, and ambiguity. The translated FNS suggested good content validity with an item-level content validity index (I-CVI) > .8, a scale-level content validity index (S-CVI)/average = .8 and a S-CVI/universal agreement = .96. Principal component analysis revealed a two-factor model: (i) willingness and trust; and (ii) rejection and fear. Cronbach's alpha for the Malay-translated FNS was .808, demonstrating high internal consistency and reliability among young Malaysian adults. Future investigators can now use this Malay-translated FNS instrument to determine levels of food neophobia among Malaysians.
  5. Joan C, Koh D, Wong JE, Khouw I, Poh BK, SEANUTS II Malaysia Study Group
    Am J Hum Biol, 2024 Mar 28.
    PMID: 38548924 DOI: 10.1002/ajhb.24076
    BACKGROUND: Adhering to 24-h movement guidelines (24-hMG) have health benefits for young children; yet research on Malaysian preschoolers' movement behaviors is limited. This study investigates the association between adherence to 24-hMG and sociodemographic factors of Malaysian preschoolers.

    METHODS: Data from 939 preschoolers aged 3-6 years (mean age = 4.83 ± 0.04 years, 53.7% boys) from the Second South East Asian Nutrition Surveys (SEANUTS II) Malaysia study was analyzed. Socio-demography, physical activity, sedentary behaviors, and sleep were parent-reported via questionnaire. Associations between adherence of 24-hMG and sociodemographic factors were analyzed using complex samples logistic regression.

    RESULTS: Only 12.1% of preschoolers adhered to the overall 24-hMG, and 67.1%, 54.7%, and 42.7% of preschoolers adhered to physical activity, sleep, and sedentary behavior guidelines, respectively; while 6.8% did not meet any guidelines. Compared to 3-4-year olds, preschoolers aged 5-6 years had higher odds of adhering to physical activity guidelines, sedentary behavior guidelines, and overall 24-hMG, but lower odds of adhering to sleep guidelines. Chinese and Indian preschoolers were more likely to adhere to sedentary behavior guidelines than Malay preschoolers; however, Chinese preschoolers had lower odds of adhering to physical activity guidelines. Paternal tertiary education was associated with a higher likelihood of adherence to sleep guidelines.

    CONCLUSION: Our findings suggest that adherence to 24-hMG among Malaysian preschoolers is associated with age, ethnicity, and paternal education level. This underscores the importance of targeted interventions and health awareness program to promote healthy movement behaviors, particularly among children under 5, ethnic minorities, and educationally disadvantaged families.

  6. Howe AS, Skidmore PM, Parnell WR, Wong JE, Lubransky AC, Black KE
    Public Health Nutr, 2016 May;19(7):1279-87.
    PMID: 26347042 DOI: 10.1017/S1368980015002566
    OBJECTIVE: To examine the association between cardiorespiratory fitness and dietary patterns in adolescents.

    DESIGN: Food choice was assessed using the validated New Zealand Adolescent FFQ. Principal components analysis was used to determine dietary patterns. Trained research assistants measured participants' height and body mass. Cardiorespiratory fitness was assessed in a subset of participants using the multistage 20 m shuttle run. The level and stage were recorded, and the corresponding VO2max was calculated. Differences in mean VO2max according to sex and BMI were assessed using t tests, while associations between cardiorespiratory fitness and dietary patterns were examined using linear regression analyses adjusted for age, sex, school attended, socio-economic deprivation and BMI.

    SETTING: Secondary schools in Otago, New Zealand.

    SUBJECTS: Students (n 279) aged 14-18 years who completed an online lifestyle survey during a class period.

    RESULTS: Principal components analysis produced three dietary patterns: 'Treat Foods', 'Fruits and Vegetables' and 'Basic Foods'. The 279 participants who provided questionnaire data and completed cardiorespiratory fitness testing had a mean age of 15·7 (sd 0·9) years. Mean VO2max was 45·8 (sd 6·9) ml/kg per min. The 'Fruits and Vegetables' pattern was positively associated with VO2max in the total sample (β=0·04; 95%CI 0·02, 0·07), girls (β=0·06; 95% CI 0·03, 0·10) and boys (β=0·03; 95% CI 0·01, 0·05).

    CONCLUSIONS: These results indicate that increase in cardiorespiratory fitness was associated with a healthier dietary pattern, suggesting both should be targeted as part of a global lifestyle approach. Longitudinal studies are needed to confirm this association in relation to health outcomes in New Zealand adolescents.

  7. Yeo GS, Lee ST, Wong JE, Khouw I, Safii NS, Poh BK, et al.
    Appetite, 2024 Oct 01;201:107607.
    PMID: 39029531 DOI: 10.1016/j.appet.2024.107607
    Malaysian children often skip breakfast, an important meal providing essential nutrients for optimal growth and maintaining proper nutritional status. Therefore, this study aims to investigate the associations between breakfast skipping with dietary intake, diet quality, and adiposity indicators among primary schoolchildren aged 6.0-12.9 years. This study involved 1383 children from the South East Asian Nutrition Surveys (SEANUTS II) Malaysia. Information collected through questionnaires included sociodemography and breakfast consumption, defined as the first meal before noon. Breakfast skipping was identified as skipping breakfast at least once a week. Anthropometric measures, including height, body weight, and waist circumference, as well as percentage of body fat, were collected. Body mass index (BMI) and waist-to-height ratio were calculated, and BMI-for-age-z-scores was determined using WHO (2007) growth reference. A one-day 24-hour dietary recall was employed to assess dietary intake, and diet quality was analyzed using Malaysian Healthy Eating Index. Binary logistic regression was applied to examine relationship between breakfast skipping on diet quality and adiposity indicators. Over one-third (36.0%) of children skipped breakfast at least once a week, resulting in lower intakes of energy, nutrients, cereals/grains, vegetables, and milk/dairy products, though not affecting total diet quality score. Breakfast skipping was associated with higher odds of overweight/obesity (aOR 2.04, 95%CI: 1.52-2.76) and central obesity (aOR 1.87, 95%CI 1.34-2.61). In conclusion, primary schoolchildren in Peninsular Malaysia who skipped breakfast tended to have lower consumption of nutrients and specific basic food groups, as well as increased body fat. This study highlights the importance of continuing to educate parents and children about healthy eating habits, especially the need to adhere to dietary recommendations, with an emphasis on breakfast consumption.
  8. 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
  9. Wong JE, Palarea-Albaladejo J, Lee ST, Koh D, Khouw I, Poh BK, et al.
    J Phys Act Health, 2025 Jan 01;22(1):100-111.
    PMID: 39496260 DOI: 10.1123/jpah.2024-0161
    BACKGROUND: Physical activity (PA), sedentary behavior (SB), and sleep are interrelated 24-hour movement behaviors that are important for the growth and well-being of children. This cross-sectional study examined the relationship between 24-hour movement behaviors and adiposity, and predicted changes in adiposity following compositional time reallocations in 7- to 12.9-year-old Malaysian children from the South East Asian Nutrition Surveys II Malaysia.

    METHODS: A total of 381 children (mean age 9.7 [1.6] y, 57% girls) provided 24-hour wrist-worn GENEActiv accelerometry data which captured time spent for sleep, SB, light PA and moderate to vigorous PA (MVPA). Indicators of adiposity were derived from anthropometry and bioelectrical impedance analysis: body-mass-index-for-age, waist circumference, waist-to-height ratio, percent body fat, and body mass index. The composition of 4-part movement behaviors was expressed as isometric log-ratio coordinates which were entered into regression models. Isotemporal substitution analysis was used to assess changes in adiposity indicators when reallocating time between movement behaviors.

    RESULTS: Relative to other movement behaviors, time spent on MVPA was significantly associated with waist circumference, waist-to-height ratio, percent body fat, and fat mass index. A 15-minute one-to-one reallocation from other movement behaviors to MVPA predicted lower body-mass-index-for-age (-0.03 to -0.11), smaller waist circumference (-0.67 to -1.28 cm), lower waist-to-height ratio (-0.004 to -0.008), percent body fat (-0.87% to -1.47%), and fat mass index (-0.23 to -0.42). Replacing SB and light PA with sleep or MVPA was associated with lower adiposity.

    CONCLUSIONS: The overall composition of movement behavior was significantly associated with the adiposity of Malaysian schoolchildren. Promoting MVPA and sleep and reducing SB and light PA are important for prevention of childhood obesity.

  10. Davison B, Saeedi P, Black K, Harrex H, Haszard J, Meredith-Jones K, et al.
    Nutrients, 2017 May 11;9(5).
    PMID: 28492490 DOI: 10.3390/nu9050483
    Previous research investigating the relationship between parents' and children's diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; 'Fruit and Vegetables' and 'Snacks'. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child 'Snacks' score. There was no significant relationship between 'Fruit and Vegetables' score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children.
  11. Wee LH, Yeap LLL, Chan CMH, Wong JE, Jamil NA, Swarna Nantha Y, et al.
    BMC Public Health, 2019 Jun 13;19(Suppl 4):540.
    PMID: 31196096 DOI: 10.1186/s12889-019-6860-8
    BACKGROUND: Organization productivity is strongly linked to employees' socioeconomic characteristics and health which is marked by absenteeism and presenteeism. This study aims to identify anteceding factors predicting employees' absenteeism and presenteeism by income, physical and mental health.

    METHODS: An online health survey was conducted between May to July 2017 among employees from 47 private companies located in urban Malaysia. A total of 5235 respondents completed the 20-min online employee health survey on a voluntary basis. Chi-Square or Fisher's exact tests were used to determine association between income with demographic and categorical factors of absenteeism and presenteeism. Multivariate linear regression was used to identify factors predicting absenteeism and presenteeism.

    RESULTS: More than one third of respondents' monthly income were less than RM4,000 (35.4%), 29.6% between RM4,000-RM7,999 and 35.0% earned RM8,000 and above. The mean age was 33.8 years (sd ± 8.8) and 49.1% were married. A majority were degree holders (74.4%) and 43.6% were very concerned about their financial status. Mean years of working was 6.2 years (sd ± 6.9) with 68.9% satisfied with their job. More than half reported good general physical health (54.5%) (p = 0.065) and mental health (53.5%) (p = 0.019). The mean hours of sleep were 6.4 h (sd ± 1.1) with 63.2% reporting being unwell due to stress for the past 12 months. Mean work time missed due to ill-health (absenteeism) was 3.1% (sd ± 9.1), 2.8% (sd ± 9.1) and 1.8% (sd ± 6.5) among employees whose monthly income was less than RM4,000, RM4,000-RM7,999 and over RM8,000 respectively (p = 0.0066). Mean impairment while working due to ill-health (presenteeism) was 28.2% (sd ± 25.3), 24.9% (sd ± 25.5) and 20.3% (sd ± 22.9) among employees whose monthly income was less than RM4,000, RM4,000-RM7,999 and over RM8,000 respectively (p 

  12. Chin YS, Appukutty M, Kagawa M, Gan WY, Wong JE, Poh BK, et al.
    Nutrients, 2020 Jan 25;12(2).
    PMID: 31991785 DOI: 10.3390/nu12020318
    Disordered eating is prevalent among university students, especially females. Whilst literature suggests that factors associated with disordered eating may differ according to gender, such an association has not been studied in Malaysia. This cross-sectional study aims to compare factors associated with disordered eating between male and female university students. A total of 716 university students (male: 27.4%; female: 72.6%) were recruited in Kuala Lumpur and Selangor, Malaysia. All participants completed a set of self-administered questionnaires and their body weight and height were recorded. About one in five of the university students (20.3%) were found to have disordered eating. There were more female students (22.9%) disordered eating compared to males (13.3%, χ² = 8.16, p < 0.05). In male students (β = 0.228, p < 0.01), depressive symptoms were the only significant predictor for disordered eating. In females, the strongest predictor was depressive symptoms (β = 0.214, p < 0.001), followed by body size satisfaction (β = -0.145, p < 0.01) and body appreciation (β = -0.101, p < 0.05). These findings suggest that there are gender differences in the factors associated with disordered eating among Malaysian university students. Intervention programmes that address disordered eating should take into account these sex differences and its contributing factors.
  13. Wong JE, Poh BK, Nik Shanita S, Izham MM, Chan KQ, Tai MD, et al.
    Singapore Med J, 2012 Nov;53(11):744-9.
    PMID: 23192502
    This study aimed to measure the basal metabolic rate (BMR) of elite athletes and develop a gender specific predictive equation to estimate their energy requirements.
  14. Chong KM, Chia A, Shah Budin NS, Poh BK, Jamil NA, Koh D, et al.
    JMIR Pediatr Parent, 2024 May 07;7:e53461.
    PMID: 38713499 DOI: 10.2196/53461
    BACKGROUND: My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children.

    OBJECTIVE: This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children's meals taken by their parents as an objective reference.

    METHODS: A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children's reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents.

    RESULTS: Overall, the match, omission, and intrusion rates were 62% (IQR 46%-86%), 39% (IQR 16%-55%), and 20% (IQR 6%-44%), respectively. Carbohydrate-based items from the food categories "rice and porridge"; "breads, spreads, and cereals"; and "noodles, pasta, and potatoes" were reported most accurately (total match rates: 68%-76%). "Snack and dessert" items were omitted most often (omission rate: 54%). Furthermore, side dishes from "vegetables and mushrooms," "eggs and tofu," "meat and fish," and "curry" food groups were often omitted (omission rates: 42%-46%). Items from "milk, cheese, and yogurt"; "snacks and desserts"; and "drinks" food groups intruded most often (intrusion rates: 37%-46%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69% vs 53%) and lesser omission rates (31% vs 49%; P=.03, respectively).

    CONCLUSIONS: In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children.

  15. 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.

  16. 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
  17. 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.

  18. 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.
  19. Saeedi P, Black KE, Haszard JJ, Skeaff S, Stoner L, Davidson B, et al.
    Nutrients, 2018 Jul 10;10(7).
    PMID: 29996543 DOI: 10.3390/nu10070887
    Research shows that cardiorespiratory (CRF) and muscular fitness in childhood are associated with a healthier cardiovascular profile in adulthood. Identifying factors associated with measures of fitness in childhood could allow for strategies to optimize cardiovascular health throughout the lifecourse. The aim of this study was to examine the association between dietary patterns and both CRF and muscular fitness in 9⁻11-year-olds. In this study of 398 children, CRF and muscular fitness were assessed using a 20-m shuttle run test and digital hand dynamometer, respectively. Dietary patterns were derived using principal component analysis. Mixed effects linear regression models were used to assess associations between dietary patterns and CRF and muscular fitness. Most children had healthy CRF (99%, FITNESSGRAM) and mean ± SD muscular fitness was 15.2 ± 3.3 kg. Two dietary patterns were identified; “Snacks” and “Fruit and Vegetables”. There were no significant associations between either of the dietary patterns and CRF. Statistically significant but not clinically meaningful associations were seen between dietary patterns and muscular fitness. In an almost exclusively fit cohort, food choice is not meaningfully related to measures of fitness. Further research to investigate diet-fitness relationships in children with lower fitness levels can identify key populations for potential investments in health-promoting behaviors.
  20. Poh BK, Lee ST, Yeo GS, Tang KC, Noor Afifah AR, Siti Hanisa A, et al.
    BMC Public Health, 2019 Jun 13;19(Suppl 4):541.
    PMID: 31196019 DOI: 10.1186/s12889-019-6856-4
    BACKGROUND: Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children.

    METHODS: A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven's Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference.

    RESULTS: Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110-119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ ( 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)].

    CONCLUSIONS: Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.

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