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UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research

Collins J, Maughan RJ, Gleeson M, Bilsborough J, Jeukendrup A, Morton JP, et al.

Br J Sports Med, 2021 Apr;55(8):416.
PMID: 33097528 DOI: 10.1136/bjsports-2019-101961

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

Matched MeSH terms: Healthy Diet*
Fulltext School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

Mohammadi S, Su TT, Jalaludin MY, Dahlui M, Azmi Mohamed MN, Papadaki A, et al.

Front Public Health, 2020;8:549637.
PMID: 33072694 DOI: 10.3389/fpubh.2020.549637

Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention. Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling "red flag" foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell "green flag" food and drinks, such as fruits and vegetables. Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.

Matched MeSH terms: Healthy Diet*
Fulltext Perceptions of eating practices and physical activity among Malaysian adolescents in secondary schools: a qualitative study with multi-stakeholders

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.

Matched MeSH terms: Healthy Diet
Fulltext Effect of Family-Based REDUCE Intervention Program on Children Eating Behavior and Dietary Intake: Randomized Controlled Field Trial

Ahmad N, Shariff ZM, Mukhtar F, Lye MS

Nutrients, 2020 Oct 08;12(10).
PMID: 33049909 DOI: 10.3390/nu12103065

The objective of this study was to evaluate the effect of a family-based intervention program (REDUCE) on children's eating behaviors and dietary intake. A two-arm randomized controlled field trial was conducted among parents and children of 7 to 10 years old who were either overweight or obese. The intervention was conducted via face-to-face sessions and social media. The child eating behaviors were assessed using the child eating behaviors questionnaire (CEBQ), while their dietary consumption of vegetables and unhealthy snacks was assessed using a parental report of three days unweighted food. The generalized linear mixed modelling adjusted for covariates was used to estimate the intervention effects with alpha of 0.05. A total of 122 parents (91% response rate) completed this study. At the six-month post-training, there were statistically significant mean differences in the enjoyment of food (F(6481) = 4.653, p < 0.001), fruit and vegetable intake (F(6480) = 4.165, p < 0.001) and unhealthy snack intake (F(6480) = 5.062, p < 0.001) between the intervention and wait-list groups; however, it was not clinically meaningful. This study added to the body of knowledge of family-based intervention that utilized social media and assessed the effect in children's eating behavior using the CEBQ and children's dietary intake.

Matched MeSH terms: Healthy Diet*
Fulltext Family-based intervention using face-to-face sessions and social media to improve Malay primary school children's adiposity: a randomized controlled field trial of the Malaysian REDUCE programme

Ahmad N, Shariff ZM, Mukhtar F, Lye MS

Nutr J, 2018 08 02;17(1):74.
PMID: 30071855 DOI: 10.1186/s12937-018-0379-1

BACKGROUND: Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions - the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme - on adiposity of Malay children.
METHODS: Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8-11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children.
RESULTS: Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup ((F(6, 517) = 2.817, p = 0.010) and (F(6, 297) = 6.072, p

Matched MeSH terms: Healthy Diet/methods; Healthy Diet/psychology
Production, safety, health effects and applications of diacylglycerol functional oil in food systems: a review

Lee YY, Tang TK, Phuah ET, Tan CP, Wang Y, Li Y, et al.

Crit Rev Food Sci Nutr, 2020;60(15):2509-2525.
PMID: 31418288 DOI: 10.1080/10408398.2019.1650001

Diacylglycerol (DAG) is a world leading anti-obesity functional cooking oil synthesized via structural modification of conventional fats and oils. DAG exits in three stereoisomers namely sn-1,2-DAG, sn-1,3-DAG, and sn-2,3-DAG. DAG particularly sn-1,3-DAG demonstrated to have the potential in suppressing body fat accumulation and lowering postprandial serum triacylglycerol, cholesterol and glucose level. DAG also showed to improve bone health. This is attributed to DAG structure itself that caused it to absorb and digest via different metabolic pathway than conventional fats and oils. With its purported health benefits, many studies attempt to enzymatically or chemically synthesis DAG through various routes. DAG has also received wide attention as low calorie fat substitute and has been incorporated into various food matrixes. Despite being claimed as healthy cooking oil the safety of DAG still remained uncertain. DAG was banned from sale as it was found to contain probable carcinogen glycidol fatty acid esters. The article aims to provide a comprehensive and latest review of DAG emphasizing on its structure and properties, safety and regulation, process developments, metabolism and beneficial health attributes as well as its applications in the food industry.

Matched MeSH terms: Healthy Diet*
Fulltext Multidomain Intervention for Reversal of Cognitive Frailty, Towards a Personalized Approach (AGELESS Trial): Study Design

Ponvel P, Shahar S, Singh DKA, Ludin AFM, Rajikan R, Rajab NF, et al.

J Alzheimers Dis, 2021;82(2):673-687.
PMID: 34092633 DOI: 10.3233/JAD-201607

BACKGROUND: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF.
OBJECTIVE: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention.
METHODS: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 165). The control group (n = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use.
RESULTS: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF.
CONCLUSION: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.

Matched MeSH terms: Healthy Diet/methods*
Fulltext Healthy and Sustainable Diet Index: Development, Application and Evaluation Using Image-Based Food Records

Harray AJ, Boushey CJ, Pollard CM, Dhaliwal SS, Mukhtar SA, Delp EJ, et al.

Nutrients, 2022 Sep 16;14(18).
PMID: 36145211 DOI: 10.3390/nu14183838

There are limited methods to assess how dietary patterns adhere to a healthy and sustainable diet. The aim of this study was to develop a theoretically derived Healthy and Sustainable Diet Index (HSDI). The HSDI uses 12 components within five categories related to environmental sustainability: animal-based foods, seasonal fruits and vegetables, ultra-processed energy-dense nutrient-poor foods, packaged foods and food waste. A maximum of 90 points indicates the highest adherence. The HSDI was applied to 4-day mobile food records (mFRTM) from 247 adults (18−30 years). The mean HSDI score was 42.7 (SD 9.3). Participants who ate meat were less likely to eat vegetables (p < 0.001) and those who ate non-animal protein foods were more likely to eat more fruit (p < 0.001), vegetables (p < 0.05), and milk, yoghurt and cheese (p < 0.05). After adjusting for age, sex and body mass index, multivariable regression found the strongest predictor of the likelihood of being in the lowest total HSDI score tertile were people who only took a bit of notice [OR (95%CI) 5.276 (1.775, 15.681) p < 0.005] or did not pay much/any attention to the health aspects of their diet [OR (95%CI) 8.308 (2.572, 26.836) p < 0.0001]. HSDI provides a new reference standard to assess adherence to a healthy and sustainable diet.

Matched MeSH terms: Healthy Diet
Fulltext Exploring Eating and Nutritional Challenges for Children with Autism Spectrum Disorder: Parents' and Special Educators' Perceptions

Ismail NAS, Ramli NS, Hamzaid NH, Hassan NI

Nutrients, 2020 Aug 20;12(9).
PMID: 32825466 DOI: 10.3390/nu12092530

Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that is frequently associated with food refusal, limited food repertoire and high-frequency single food intake mainly among children with ASD. Provision of nutrition can be very challenging due to the fact of these behavioural problems, either for the parents or special educators. Healthy nutrition is associated with providing and consuming nutritious food with results being in a good state of health. Semi-structured focus group discussions (FGDs) were conducted among 20 participants at a National Autism Centre to explore their understanding towards healthy nutrition. They were parents and special educators who were actively involved with children with ASD. A series of discussions were transcribed verbatim, and four researchers examined each transcript. Inductive analysis linking codes into main thematic categories was conducted using the constant comparison approach across the full data set. The outcome suggested that participants had limited knowledge relating to the proper dietary and nutritional needs of the children. The key messages from the discussion provide a foundation on the development of a nutrition education module which involves primary caretakers of children with ASD.

Matched MeSH terms: Healthy Diet*
Application of seaweeds to develop new food products with enhanced shelf-life, quality and health-related beneficial properties

Roohinejad S, Koubaa M, Barba FJ, Saljoughian S, Amid M, Greiner R

Food Res Int, 2017 09;99(Pt 3):1066-1083.
PMID: 28865618 DOI: 10.1016/j.foodres.2016.08.016

Edible seaweeds are a good source of antioxidants, dietary fibers, essential amino acids, vitamins, phytochemicals, polyunsaturated fatty acids, and minerals. Many studies have evaluated the gelling, thickening and therapeutic properties of seaweeds when they are used individually. This review gives an overview on the nutritional, textural, sensorial, and health-related properties of food products enriched with seaweeds and seaweed extracts. The effect of seaweed incorporation on properties of meat, fish, bakery, and other food products were highlighted in depth. Moreover, the positive effects of foods enriched with seaweeds and seaweed extracts on different lifestyle diseases such as obesity, dyslipidemia, hypertension, and diabetes were also discussed. The results of the studies demonstrated that the addition of seaweeds, in powder or extract form, can improve the nutritional and textural properties of food products. Additionally, low-fat products with less calories and less saturated fatty acids can be prepared using seaweeds. Moreover, the addition of seaweeds also affected the health properties of food products. The results of these studies demonstrated that the health value, shelf-life and overall quality of foods can be improved through the addition of either seaweeds or seaweed extracts.

Matched MeSH terms: Healthy Diet*
Dietary Phytochemicals: Natural Swords Combating Inflammation and Oxidation-Mediated Degenerative Diseases

Islam MA, Alam F, Solayman M, Khalil MI, Kamal MA, Gan SH

Oxid Med Cell Longev, 2016;2016:5137431.
PMID: 27721914

Cumulatively, degenerative disease is one of the most fatal groups of diseases, and it contributes to the mortality and poor quality of life in the world while increasing the economic burden of the sufferers. Oxidative stress and inflammation are the major pathogenic causes of degenerative diseases such as rheumatoid arthritis (RA), diabetes mellitus (DM), and cardiovascular disease (CVD). Although a number of synthetic medications are used to treat these diseases, none of the current regimens are completely safe. Phytochemicals (polyphenols, carotenoids, anthocyanins, alkaloids, glycosides, saponins, and terpenes) from natural products such as dietary fruits, vegetables, and spices are potential sources of alternative medications to attenuate the oxidative stress and inflammation associated with degenerative diseases. Based on in vitro, in vivo, and clinical trials, some of these active compounds have shown good promise for development into novel agents for treating RA, DM, and CVD by targeting oxidative stress and inflammation. In this review, phytochemicals from natural products with the potential of ameliorating degenerative disease involving the bone, metabolism, and the heart are described.

Matched MeSH terms: Healthy Diet*
Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study

Mousavi SM, Milajerdi A, Pouraram H, Saadatnia M, Shakeri F, Keshteli AH, et al.

Int J Vitam Nutr Res, 2021 Jan;91(1-2):48-55.
PMID: 31259666 DOI: 10.1024/0300-9831/a000603

Background: Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. Methods: In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Results: Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P diet and stroke.

Matched MeSH terms: Healthy Diet*
Fulltext Diet optimization using linear programming to develop low cost cancer prevention food plan for selected adults in Kuala Lumpur, Malaysia

Alaini R, Rajikan R, Elias SM

BMC Public Health, 2019 Jun 13;19(Suppl 4):546.
PMID: 31196148 DOI: 10.1186/s12889-019-6872-4

BACKGROUND: Poor dietary habits have been identified as one of the cancer risks factors in various epidemiological studies. Consumption of healthy and balance diet is crucial to reduce cancer risk. Cancer prevention food plan should consist of all the right amounts of macronutrients and micronutrients. Although dietary habits could be changed, affordability of healthy foods has been a major concern, as the price of healthy foods are more expensive the unhealthy counterparts.
METHODS: Therefore, using linear programming, this study is aimed to develop a healthy and balanced menu with minimal cost in accordance to individual needs that could in return help to prevent cancer. A cross sectional study involving 100 adults from a local university in Kuala Lumpur was conducted in 3 phases. The first phase is the data collection for the subjects, which includes their socio demographic, anthropometry and diet recall. The second phase was the creation of a balanced diet model at a minimum cost. The third and final phase was the finalization of the cancer prevention menu. Optimal and balanced menus were produced based on respective guidelines of WCRF/AICR (World Cancer Research Fund/ American Institute for Cancer Research) 2007, MDG (Malaysian Dietary Guidelines) 2010 and RNI (Recommended Nutrient Intake) 2017, with minimum cost.
RESULTS: Based on the diet recall, most of subjects did not achieve the recommended micronutrient intake for fiber, calcium, potassium, iron, B12, folate, vitamin A, vitamin E, vitamin K, and beta-carotene. While, the intake of sugar (51 ± 19.8 g), (13% ± 2%) and sodium (2585 ± 544 g) was more than recommended. From the optimization model, three menus, which met the dietary guidelines for cancer prevention by WCRF/AICR 2007, MDG 2010 and RNI 2017, with minimum cost of RM7.8, RM9.2 and RM9.7 per day were created.
CONCLUSION: Linear programming can be used to translate nutritional requirements based on selected Dietary Guidelines to achieve a healthy, well-balanced menu for cancer prevention at minimal cost. Furthermore, the models could help to shape consumer food choice decision to prevent cancer especially for those in low income group where high cost for health food has been the main deterrent for healthy eating.

Matched MeSH terms: Healthy Diet/economics; Healthy Diet/methods*
Fulltext Adherence to the WCRF/AICR Dietary Recommendations for Cancer Prevention and Risk of Cancer in Elderly from Europe and the United States: A Meta-Analysis within the CHANCES Project

Jankovic N, Geelen A, Winkels RM, Mwungura B, Fedirko V, Jenab M, et al.

Cancer Epidemiol Biomarkers Prev, 2017 Jan;26(1):136-144.
PMID: 27793797 DOI: 10.1158/1055-9965.EPI-16-0428

BACKGROUND: It is unknown whether dietary recommendations for cancer prevention are applicable to the elderly. We analyzed WCRF/AICR recommendations in cohorts of European and U.S. adults ages 60 years and above.
METHODS: Individual participant data meta-analysis included 362,114 participants (43% women), from seven prospective cohort studies, free from cancer at enrollment. The WCRF/AICR diet score was based on: (i) energy-dense foods and sugary drinks, (ii) plant foods, (iii) red and processed meat, and (iv) alcoholic drinks. Cox proportional hazards regression was used to examine the association between the diet score and cancer risks. Adjusted, cohort-specific HRs were pooled using random-effects meta-analysis. Risk advancement periods (RAP) were calculated to quantify the time period by which the risk of cancer was postponed among those adhering to the recommendations.
RESULTS: After a median follow-up of 11 to 15 years across cohorts, 70,877 cancer cases were identified. Each one-point increase in the WCRF/AICR diet score [range, 0 (no) to 4 (complete adherence)] was significantly associated with a lower risk of total cancer [HR, 0.94; 95% confidence interval (CI), 0.92-0.97], cancers of the colorectum (HR, 0.84; 95% CI, 0.80-0.89) and prostate (HR, 0.94; 95% CI, 0.92-0.97), but not breast or lung. Adherence to an additional component of the WCRF/AICR diet score significantly postponed the incidence of cancer at any site by 1.6 years (RAP, -1.6; 95% CI, -4.09 to -2.16).
CONCLUSIONS: Adherence to WCRF/AICR dietary recommendations is associated with lower risk of cancer among older adults.
IMPACT: Dietary recommendations for cancer prevention are applicable to the elderly. Cancer Epidemiol Biomarkers Prev; 26(1); 136-44. ©2016 AACR.

Matched MeSH terms: Healthy Diet*
Relationship between work-family conflict and unhealthy eating: Does eating style matter?

Shukri M, Jones F, Conner M

Appetite, 2018 04 01;123:225-232.
PMID: 29294321 DOI: 10.1016/j.appet.2017.12.027

There is increasing evidence to suggest that work-family conflict is implicated in poor eating patterns. Yet, the underlying mechanism remains unexplored. The objectives of the present study were to demonstrate the interplay between work-family conflict, eating style, and unhealthy eating, and to test whether body mass index (BMI) and its interactions further explicate the relationships. In this study, 586 Malaysian adults (normal weight n = 437, overweight n = 149) completed a questionnaire, which included demographic variables, work-family scales, eating style measures, namely, restrained, emotional or external eating and reported food intake. As hypothesized, results showed that family-to-work conflict (FWC), emotional eating and external eating were positively related to unhealthy food consumption. In addition, emotional eating was found to moderate the impact of FCW on eating. These findings are consistent with research that has revealed emotional eating can indeed increase the positive association between stress such as conflict and unhealthy food choices. However, we found no clear support for the interactive effects of BMI. Our research builds on the findings of existing research as it demonstrates the role of eating style in explaining the association between work-family conflict and unhealthy eating. This conclusion has potential implications for appropriate interventions and calls for the enhancement of various policies to tackle obesity and other health problems.

Matched MeSH terms: Healthy Diet/psychology*
Fulltext Investing in early nutrition and food systems for human and planetary health

Hollis JL, Demaio S, Yang WY, Trijsburg L, Brouwer ID, Jewell J, et al.

Lancet Child Adolesc Health, 2021 Nov;5(11):772-774.
PMID: 34606769 DOI: 10.1016/S2352-4642(21)00306-0
Matched MeSH terms: Healthy Diet*
Evaluation of the Effectiveness of a 3-Year, Teacher-Led Healthy Lifestyle Program on Eating Behaviors Among Adolescents Living in Day School Hostels in Malaysia

Teng CY, Chin YS, Taib MNM, Chan YM

Food Nutr Bull, 2018 12;39(4):595-607.
PMID: 30407077 DOI: 10.1177/0379572118795358

BACKGROUND: Independence gained during adolescence may be associated with unhealthy eating behaviors. Although malnutrition among adolescents is evident, studies on eating behaviors among adolescents are scarce.
OBJECTIVE: To determine the effectiveness of a teacher-led Healthy Lifestyle Program on eating behaviors among adolescents in Malaysia.
METHODS: This was a cluster randomized controlled trial (conducted in 2012 to 2014), with 100 schools randomly selected from 721 schools, then assigned to 50 intervention schools and 50 control schools. A Healthy Eating and Be Active among Teens (HEBAT) module was developed for pretrained teachers to deliver a Healthy Lifestyle Program on eating behaviors among adolescents. Eating behaviors of the respondents was determined using Eating Behaviors Questionnaire. Linear Mixed Model analysis and χ2 test were used to determine within- and between-group effects of studied variables.
RESULTS: A total of 4277 respondents participated in this study, with 2635 samples involved in the final analysis, comprised of 921 intervention and 1714 control respondents. There were 32.4% (36.4%) males and 67.6% (63.6%) females in the intervention (control) group. Mean age was comparable between the groups (intervention = 12.98 years; control = 12.97 years). Majority of the respondents skipped meals at baseline (intervention = 74.7%; control = 79.5%). After the program, intervention respondents had higher consumption frequency of lunch, dinner, and mid-morning snack but a lower consumption frequency of late-evening snack and meal skipping behaviors than their control counterparts.
CONCLUSION: The teacher-led Healthy Lifestyle Program was effective in reducing meal-skipping behaviors among Malaysian adolescents.

Matched MeSH terms: Healthy Diet/statistics & numerical data*
Cardiorespiratory fitness is positively associated with a healthy dietary pattern in New Zealand adolescents

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.

Matched MeSH terms: Healthy Diet*
Fulltext Effectiveness of education intervention, with regards to physical activity level and a healthy diet, among Middle Eastern adolescents in Malaysia: A study protocol for a randomized control trial, based on a health belief model

Al-Haroni H, Nik Farid ND, Azanan MS

PLoS One, 2024;19(1):e0289937.
PMID: 38232100 DOI: 10.1371/journal.pone.0289937

BACKGROUND: Among the most urgent public health challenges, of the twenty-first century, is obesity. This can be attributed to its relationship with several non-communicable diseases (NCDs), as well as premature mortality. Being overweight or obese is a major concern not only in high-income countries, but also in low-income and middle-income countries, particularly in urban areas. Several studies have highlighted the prevalence of obesity, among Middle Eastern-descent adolescents, studying in Arabic secondary schools, located in Malaysia. Intervention studies, directed at Middle Eastern adolescents in Malaysia, are limited. This paper, describes the protocol, for an integrated health education intervention process. Titled 'Healthy lifestyle', it is a primary prevention process, aimed at curbing obesity and disordered eating, among Middle Eastern secondary school adolescents, aged 13-14 years old, residing in Malaysia.
METHODS AND ANTICIPATED RESULTS: A cluster randomized controlled study will be conducted, involving 250 Middle Eastern adolescents, in Arabic schools in Malaysia. The participants will be randomly assigned to the intervention and control groups. While the intervention group participates in six weeks of fortnightly six sessions (45 minutes per session), the control group will carry on with their regular curriculums, and normal physical activity routines. The variables which will be evaluated include anthropometric measurements, knowledge, attitude, daily routines, physical activity, sedentary behaviour, food assessment, eating attitudes test-26, and a structured questionnaire based on the HBM. Data will be collected from the intervention and control groups at baseline, post-intervention, and two months following the intervention. Data analysis will be performed by way of the SPSS Statistics software version 26. The generalized estimating equation (GEE) will be used, to test the effect of the intervention program, with regards to the selected variables (outcomes), between and within-group at baseline, as well as six weeks and two months following intervention, after adjusting for clustering. Outcomes will be assessed at each time point, along with a derived average over all three-time points; thus, ensuring that both the cumulative and overall effects are determined.
CONCLUSIONS: This trial will provide useful information for improving the knowledge, attitude, and practices of Middle Eastern adolescents, with regards to body weight status, physical activity level, nutrition status (BMI and dietary intake), and disordered eating. This will go a long way, towards ensuring their adherence to appropriate physical activities, and a healthy diet, to keep non-communicable diseases at bay.
TRIAL REGISTRATION: This study is registered at NCT: NCT05694143.

Matched MeSH terms: Healthy Diet*
Fulltext Higher Dietary Cost Is Associated with Higher Diet Quality: A Cross-Sectional Study among Selected Malaysian Adults

Pondor I, Gan WY, Appannah G

Nutrients, 2017 Sep 16;9(9).
PMID: 28926947 DOI: 10.3390/nu9091028

Food price is a determining factor of food choices; however its relationship with diet quality is unclear in Malaysia. This study aimed to examine socio-economic characteristics and daily dietary cost (DDC) in relation to diet quality in the state of Selangor, Malaysia. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and diet quality was estimated using a Malaysian Healthy Eating Index (M-HEI). DDC in Malaysian Ringgit (RM) was calculated from dietary intake and national food prices. Linear regression models were fitted to determine associations between DDC and M-HEI scores and predictors of diet quality. The mean M-HEI score of respondents was 61.31 ± 10.88 and energy adjusted DDC was RM10.71/2000 kcal (USD 2.49). The highest quintile of adjusted DDC had higher M-HEI scores for all respondents (Q1: 57.14 ± 10.07 versus Q5: 63.26 ± 11.54, p = 0.001). There were also positive associations between DDC and M-HEI scores for fruits (p < 0.001) and vegetables (p = 0.017) for all respondents. Predictors of diet quality included carbohydrate (β = 0290; p < 0.001) and fat intakes (β = -0.242; p < 0.001) and energy adjusted DDC (β = 0.196; p < 0.001). Higher dietary cost is associated with healthy eating among Malaysian adults.

Matched MeSH terms: Healthy Diet/economics

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