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eToyBox is a learning management system for preschool teachers to improve their health literacy, which ultimately aims to improve children's obesity-related behaviour. As part of the development process of eToyBox, assessment on digital literacy, acceptance of digitization of education materials, and perceived barriers in adopting online learning is needed. Fifty-four preschool teachers under the Community Development Department (KEMAS) in Kuala Lumpur, Selangor, and Sarawak, who participated in ToyBox Study Malaysia intervention in 2018, took part in this cross-sectional study. An online self-administered questionnaire was used to assess sociodemographic background, use of communication tools and media, and teacher's views on adapting the ToyBox modules to digital education materials. Respondents were contacted, and questionnaire link was shared through WhatsApp messages. Most participants (74.0%) were Malay females aged 31 to 40 years old. Most participants had internet access (94.4%) and owned at least a smart phone, laptop or tablet (94.4%). Participants perceived their computer skills to be average (75.0%). Majority of respondents (65.0%) reported advanced and higher abilities in word processing and email, but only 22.0% in spreadsheet skills. The main barrier to accessing online material was unstable internet connection (74.1%). Most respondents (90.0%) agree that adapting effective modules to online learning will be beneficial for professional development and teaching practices. In conclusion, most participants supported digitizing Toybox Study Malaysia educational content and were comfortable with its implementation via an online learning platform. The findings from this study can advise future development of online learning materials for preschool teachers in Malaysia. [ABSTRACT FROM AUTHOR]

Objective: To assess the nutritional status, growth parameters and lifestyle behaviours of children between 0·5 and 12 years in nationally representative samples in Malaysia, Indonesia, Thailand and Vietnam. Design: A cross-sectional study was conducted in the four countries, between May 2019 and April 2021. Data collected can be categorised into four categories: (1) Growth – anthropometry, body composition, development disorder, (2) nutrient intake and dietary habits – 24-h dietary recall, child food habits, breast-feeding and complementary feeding, (3) socio-economic status – food insecurity and child health status/environmental and (4) lifestyle behaviours – physical activity patterns, fitness, sunlight exposure, sleep patterns, body image and behavioural problems. Blood samples were also collected for biochemical and metabolomic analyses. With the pandemic emerging during the study, a COVID-19 questionnaire was developed and implemented. Setting: Both rural and urban areas in Malaysia, Indonesia, Thailand and Vietnam. Participants: Children who were well, with no physical disability or serious infections/injuries and between the age of 0·5 and 12 years old, were recruited. Results: The South East Asian Nutrition Surveys II recruited 13 933 children. Depending on the country, data collection from children was conducted in schools and commune health centres, or temples, or sub-district administrative organisations. Conclusions: The results will provide up-to-date insights into nutritional status and lifestyle behaviours of children in the four countries. Subsequently, these data will facilitate exploration of potential gaps in dietary intake among Southeast Asian children and enable local authorities to plan future nutrition and lifestyle intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to report South East Asian Nutrition Surveys (SEANUTS) II Malaysia data on nutritional status, dietary intake and nutritional biomarkers of children aged 6 months to 12 years. Design: Cross-sectional survey conducted in 2019–2020. Setting: Multistage cluster sampling conducted in Central, Northern, Southern and East Coast regions of Peninsular Malaysia. Participants: 2989 children aged 0·5–12·9 years. Results: Prevalences of stunting, thinness, overweight and obesity among children aged 0·5–12·9 years were 8·9 %, 6·7 %, 9·2 % and 8·8 %, respectively. Among children below 5 years old, 11·4 % were underweight, 13·8 % had stunting and 6·2 % had wasting. Data on nutritional biomarkers showed that a small proportion of children aged 4–12 years had Fe (2·9 %) and vitamin A deficiencies (3·1 %). Prevalence of anaemia was distinctly different between children below 4 years old (40·3 %) and those aged 4 years and above (3·0 %). One-fourth of children (25·1 %) had vitamin D insufficiency, which was twice as prevalent in girls (35·2 % v. boys: 15·6 %). The majority of children did not meet the recommended dietary intake for Ca (79·4 %) and vitamin D (94·8 %). Conclusions: Data from SEANUTS II Malaysia confirmed that triple burden of malnutrition coexist among children in Peninsular Malaysia, with higher prevalence of overnutrition than undernutrition. Anaemia is highly prevalent among children below 4 years old, while vitamin D insufficiency is more prevalent among girls. Low intakes of dietary Ca and vitamin D are also of concern. These findings provide policymakers with useful and evidence-based data to formulate strategies that address the nutritional issues of Malaysian children. [ABSTRACT FROM AUTHOR]

Dietary patterns formed during early childhood track into adulthood. Poor dietary patterns during early years may hinder children's normal growth, development, and predispose children to short- or long-term health implications. A posteriori dietary pattern analysis has been extensively used to characterise the overall diet of specific populations, providing valuable insights for targeted nutrition intervention. This review aims to unravel the relationship between dietary patterns and its associated factors among preschool children aged two to six years. Article search was performed using electronic databases including Google Scholar, PubMed (Medline), Web of Science and Scopus. A total of 12 studies were included in the review. The commonly identified dietary patterns among preschool children are made up of unhealthy or lower diet quality foods. Various determinants including sociodemographic, socioeconomic and lifestyle characteristics have also been linked with these dietary patterns. Therefore, it is crucial to address these multifactorial determinants when developing healthy eating habits promotion or intervention program at early age to ensure the effectiveness. [ABSTRACT FROM AUTHOR]

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 (< 80). Children with severe obesity (BAZ > 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Understanding of psychosocial factors of physical activity (PA) in children is crucial in encouraging sustained PA, which in turn is associated with important health outcomes. This study aimed to examine how children's attraction to physical activity (CAPA) is associated with PA. Methods: This cross-sectional study was conducted among 219 primary school children (105 boys; 114 girls) aged 7 years old--10 years old in Kuala Lumpur, Malaysia in 2016-2017. Children from three main ethnicities, namely Malay, Chinese and Indian, were recruited. Weight, height and waist circumference were measured; body composition was assessed by deuterium dilution technique. CAPA and level of PA were obtained through self-administered questionnaires and reported as CAPA and PA scores. Results: Median CAPA and PA scores were 3.40 (Q1 = 3.00, Q3 = 3.80) and 2.31 (Q1 = 1.95, Q3 = 2.74), respectively. Significant gender differences were found in CAPA and PA scores, with boys being more attracted to PA (3.16 [Q1 = 2.90, Q3 = 3.44]; P = 0.001) and more physically active compared with girls (2.47 [Q1 = 2.07, Q3 = 3.07]; P = 0.001). CAPA and PA scores correlated positively in both sexes. Boys scored higher than girls in 'liking of games and sports' (ρ = 0.301, P = 0.002) and 'liking of vigorous PA' (ρ = 0.227, P = 0.02) CAPA subscales, which also correlated positively with PA scores. Girls' PA scores correlated with 'peer acceptance in games and sports' (ρ = 0.329, P < 0.001). Conclusion: Boys are more physically active and have higher attraction to PA compared with girls. Differences in PA scores between the sexes were related to gender differences in CAPA scores. Thus, attention should be given to gender differences in CAPA related psychosocial factors when planning interventions to promote PA among children. [ABSTRACT FROM AUTHOR]

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

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. [ABSTRACT FROM AUTHOR]

A basal metabolic rate(BMR) that is too low is an indicator of a poor physical condition, and could be one of the reasons for overweight. Measuring BMR though, is a time-consuming exercise, and there has long been interest in developing statistical models to predict BMR from demographic and anthropometric measurements. Poh et al. [1] developed ordinary linear regression models on a cohort of 139 Malaysian children measured three years bi-annually. However, since each child contributed six times to the total data set, these models ignore the correlated nature of the data. We re-analyzed these data using correlated linear models. We show that our approach taking correlation into account is important to establish important covariates, but does not improve prediction. [ABSTRACT FROM AUTHOR]

Background The aim of this cross-sectional study was to examine the ability of a children's physical activity questionnaire ( cPAQ) to assess physical activity levels and bone health status of school children. Methods Subjects consisted of 90 pre-pubertal and early pubertal children aged 9-10 years. Components of physical activity were assessed using metabolic intensity ( METPA) scores and mechanical bone strain ( MECHPA) scores. An Actical accelerometer was used to validate METPA scores among a sub-sample of 57 children. Reliability was assessed by test-retesting all children after a 7 day interval. Whole body bone mineral content ( BMC) was measured using dual-energy X-ray absorptiometry. Results The reliability of cPAQ for assessment of various categories of physical activity was moderate to high ( r ranged from 0.55 to 0.68, P < 0.001). Agreement was fair for repeated use of the cPAQ ( Cohen's kappa = 0.32, P < 0.001). Bland-Altman plots show cPAQ had fair agreement only for moderate activity (mean difference 35.4 min/week; 95% limits of agreement −434.0 to +504.9 min/week). Approximately 69.6% of children were correctly classified (into the same or adjacent quartiles) according to the quartiles of BMC for METPA score, and 58.7% were correctly classified according to MECHPA score. Only 10.9% and 12.0% of children were grossly misclassified as compared to METPA and MECHPA scores, respectively. Conclusions The cPAQ has reasonable validity in assessing moderate physical activity, and it demonstrates good ability to accurately classify children according to BMC. It fails, however, to assess other activity levels, suggesting that objective measurement is still a better method of assessment of physical activity among primary school children. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to assess the physical activity levels of pediatric patients with acute leukemia undergoing chemotherapy. Thirty-eight pediatric patients and matched controls, aged 3–12 years old, were measured for weight, height, and other anthropometric parameters. Physical activity was assessed using actical accelerometer and activity log book. Patients recorded significantly lower mean total activity counts (26.2±30.2cpm vs. 192.2±68.8cpm; p <0.01) and spent more time in sedentary activities (1301±121min vs. 1020±101min; p <0.001) compared to controls. They also achieved fewer 1–5-min bouts of moderate–vigorous physical activity (MVPA) compared to controls (1.50±5.95 vs. 37.38±40.36; p <0.001). In conclusion, patients had lower physical activity level and intensity; and simple exercise intervention programs may be needed to minimize the detrimental effects of prolonged sedentary behaviors. [Copyright &y& Elsevier]

Increased cardiometabolic risk among children is increasingly becoming a concern, with evidence indicating that obesity, diet, and serum 25-hydroxyvitamin D (25(OH)D) are associated with cardiometabolic risk. However, such studies among Malaysian children are scarce. Thus, this study explores the associations between adiposity, dietary quality, and 25(OH)D, with cardiometabolic risk factors among Malaysian children aged 4–12 years. Data of 479 children (mean age: 8.2 ± 2.3 years old, 52% females) from the South East Asian Nutrition Surveys (SEANUTS II) Malaysia, were included in this analysis. Adiposity (percentage of body fat) was assessed with bioelectrical impedance technique. Dietary quality was assessed using 24 h dietary recall and calculated as mean adequacy ratio. Vitamin D was assessed based on serum 25-hydroxyvitamin D (25(OH)D). Measurements of cardiometabolic risk factors included waist circumference (WC), mean arterial pressure (MAP), fasting blood glucose (FBG), high-density lipoprotein (HDL), triglyceride, and high-sensitivity C-reactive protein, and cardiometabolic risk cluster score (siMS) was calculated. Overall, higher adiposity was positively associated with all cardiometabolic risk factors (WC, ß = 0.907; 95% CI = 0.865, 0.948; MAP, ß = 0.225; 95% CI = 0.158, 0.292; HDL, ß = −0.011; 95% CI = −0.014, −0.009; Triglyceride, ß = 0.012; 95% CI = 0.009, 0.016; FBG, ß = 0.006; 95% CI = 0.002, 0.011) and siMS score (ß = 0.033; 95% CI = 0.029, 0.037). Serum 25(OH)D was inversely associated with siMS score (ß = −0.002; 95% CI = −0.004, −0.000008) and positively associated with HDL (ß = 0.002; 95% CI = 0.0001, 0.003). Our findings suggest that adiposity is a key determinant of adverse cardiometabolic risk factors in children, while serum 25(OH)D may be associated with overall cardiometabolic health. Interventions to reduce obesity are needed to mitigate the deleterious consequences of cardiometabolic dysregulation in children. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Early childhood is a critical developmental stage where established dietary patterns can impact lifelong health outcomes. This study investigates dietary patterns and their relationships with sociodemographic factors among Malaysian preschoolers. A total of 643 preschoolers of Malay, Indian, Chinese and other ethnicities participating in South East Asian Nutrition Surveys (SEANUTS II) were included. Dietary intake was assessed using a single triple‐pass 24‐h dietary recall method. Dietary patterns were derived using principal component analysis and their association with sociodemographic factors was determined using complex sampling logistic regressions. Five dietary patterns were identified: "healthy eating," "wholegrains and starchy vegetables," "high salt and sugar," "Western food," and "sugary drinks and legumes". Having older siblings was inversely associated with a "healthy eating" pattern (adjusted OR: 0.54, 95% CI: 0.33–0.87). Malay ethnicity was associated with higher odds of adhering to the "high salt and sugar" pattern (adjusted OR: 4.12, 95% CI: 2.20–7.75). Meanwhile, children living in urban areas (adjusted OR: 1.76, 95% CI: 1.03–3.01), those from middle‐income families (adjusted OR: 3.20, 95% CI: 1.38–7.40) and whose fathers were overweight (adjusted OR: 2.79, 95% CI: 1.58–4.94) showed a higher association with "Western food" pattern. Conversely, children whose mothers had overweight were less likely to adhere to the "Western food" pattern (adjusted OR: 0.50, 95% CI: 0.30–0.83). Older age was significantly associated with a greater likelihood of the "sugary drinks and legumes" pattern (adjusted OR: 3.99, 95% CI: 1.75–9.06). There was no significant association between "wholegrains and starchy vegetables" pattern with sociodemographic characteristics (all p > 0.05). These findings suggest that ethnicity, age, residence area, having older siblings, parental weight status and household income level are associated with dietary patterns among multiethnic preschoolers in Malaysia. Thus, these sociodemographic characteristics should be considered when designing targeted dietary strategies and interventions for preschoolers. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Several predictive equations have been developed for estimation of resting energy expenditure, but no study has been done to compare predictive equations against indirect calorimetry among critically ill patients at different phases of critical illness. This study aimed to determine the degree of agreement and accuracy of predictive equations among ICU patients during acute phase (≤ 5 d), late phase (6-10 d), and chronic phase (≥ 11 d).Design: This was a single-center prospective observational study that compared resting energy expenditure estimated by 15 commonly used predictive equations against resting energy expenditure measured by indirect calorimetry at different phases. Degree of agreement between resting energy expenditure calculated by predictive equations and resting energy expenditure measured by indirect calorimetry was analyzed using intraclass correlation coefficient and Bland-Altman analyses. Resting energy expenditure values calculated from predictive equations differing by ± 10% from resting energy expenditure measured by indirect calorimetry was used to assess accuracy. A score ranking method was developed to determine the best predictive equations.Setting: General Intensive Care Unit, University of Malaya Medical Centre.Patients: Mechanically ventilated critically ill patients.Interventions: None.Measurements and Main Results: Indirect calorimetry was measured thrice during acute, late, and chronic phases among 305, 180, and 91 ICU patients, respectively. There were significant differences (F= 3.447; p = 0.034) in mean resting energy expenditure measured by indirect calorimetry among the three phases. Pairwise comparison showed mean resting energy expenditure measured by indirect calorimetry in late phase (1,878 ± 517 kcal) was significantly higher than during acute phase (1,765 ± 456 kcal) (p = 0.037). The predictive equations with the best agreement and accuracy for acute phase was Swinamer (1990), for late phase was Brandi (1999) and Swinamer (1990), and for chronic phase was Swinamer (1990). None of the resting energy expenditure calculated from predictive equations showed very good agreement or accuracy.Conclusions: Predictive equations tend to either over- or underestimate resting energy expenditure at different phases. Predictive equations with "dynamic" variables and respiratory data had better agreement with resting energy expenditure measured by indirect calorimetry compared with predictive equations developed for healthy adults or predictive equations based on "static" variables. Although none of the resting energy expenditure calculated from predictive equations had very good agreement, Swinamer (1990) appears to provide relatively good agreement across three phases and could be used to predict resting energy expenditure when indirect calorimetry is not available. [ABSTRACT FROM AUTHOR]

• The incidence of metabolic syndrome and its components in Vietnamese kidney transplantation has been documented. • The study reported the dietary intake of Vietnamese kidney transplant recipients. • Physical and mental health were negatively associated with dietary intake and metabolic syndrome. Although metabolic syndrome (MetS) is a significant risk factor, and dietary intake may affect the quality of life (QoL) of kidney transplant recipients (KTRs), the association between them are unclear. This study identified MetS and nutritional factors associated with the QoL of KTRs. This study reports baseline data from a longitudinal study that was conducted at a hospital in Vietnam. KTRs aged ≥18 years and >3 months post-transplantation were recruited. Assessments included sociodemographic and blood biomarkers. Dietary intake was estimated from 24-hour recalls. A Short Form-36 Health Survey, comprising physical (PCS) and mental component summaries (MCS), was administered to assess QoL. Multivariate linear regression models were performed. The study included 106 patients (79 men) with a mean age of 43.2 years (± 11.9). Mean duration after kidney transplantation was 28.5 months (± 14.9). Patients with MetS had 6.43 lower PCS score (P <.05) and 3.20 lower MCS score (P <.05) than their counterparts without MetS. Calcium intake (β = –0.01; 95% CI, –0.03 to 0.00) and inadequate protein (β = –14.8; 95% CI, –23 to –6.65) were negatively associated with PCS score. MCS score was negatively associated with calcium intake (β = –0.02; 95% CI, –0.04 to –0.01) and inadequate protein intake (β = –15.1; 95% CI, –24.3 to –5.86), and positively associated with fat intake (β = 0.43, 95% CI, 0.02–0.85). MetS and poor dietary intake are independently associated with the QoL of KTRs. Nutritional intervention plans developed specifically for the recipients will improve dietary intake, reduce the incidence of MetS, and help enhance QoL. [ABSTRACT FROM AUTHOR]

Background: Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers. Methods: We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a 'hybrid' GMB format combining online and in person facilitation to reduce travel and associated climate impact. Results: Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The 'hybrid' GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process. Conclusions: Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The 'hybrid' GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF. [ABSTRACT FROM AUTHOR]

Inclination towards nutrition beliefs by parents and caregivers plays an important role in the dietary intake of children with leukemia. However, local studies examining on the nutrition practices and dietary beliefs among caregivers of leukemia patients are very limited. This study aims to assess nutrition beliefs among caregivers of children with leukemia and healthcare professionals at the Pediatric Institute of Kuala Lumpur Hospital (IPHKL), Malaysia. This qualitative study was conducted to assess the beliefs and practices towards certain foods among caregivers of pediatric leukemia patients. Thirty subjects comprising a group of 10 health care professionals and 20 caregivers were interviewed using semi-structured interview method. The interviews were transcribed and analyzed using ATLAS.ti. version 7.5.6 qualitative analysis software and subsequently several themes. were obtained. Five themes emerged from this analysis that are (1) beliefs about foods that can cure cancer, (2) beliefs related to consumption of meat and dairy products, (3) beliefs towards foods containing pesticides, (4) beliefs that certain food causes itchiness, and (5) source of nutrition information and nutrition knowledge of caregivers. This study proves that beliefs in various myths related to nutrition and dietary practices exist among caregivers and health professionals group. Information from these findings can provide perspective on the beliefs towards dietary practices among caregivers of children with leukemia and healthcare professionals. This is important for the healthcare professions, especially when planning the strategies for caregivers' nutrition education in order to improve the nutritional status of childhood leukemia patients. [ABSTRACT FROM AUTHOR]

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

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. [ABSTRACT FROM AUTHOR]

Purpose: There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample. Methods: This multinational, cross-sectional study included data from 1071 children 3–5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density. Results: Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d−1 was spent in seated transport. Children from upper-middle–income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle–income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures. Conclusions: These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting. [ABSTRACT FROM AUTHOR]

Background: Obesity or being overweight is a major health problem in Iran. Only few studies are available that compare the obesity prevalence by four different available criteria. The aim of this study was to determine the prevalence of overweight and obesity among Isfahani adolescents based on four different definitions. Materials and Methods: This cross-sectional study was conducted on 3002 Isfahani students (1377 males; 1625 females) aged 11-18 years. Anthropometric measurements including weight and height were measured and body mass index (BMI) was calculated. Sex-specific BMI-for-age reference data of the Iranian national data, Center for Disease Control data (CDC2000), International Obesity taskforce data (IOTF), and recent World Health Organization (WHO) data was used to define overweight and obesity. Results: The mean age of the studied population was 14.8 years and the mean BMI was 20.3 kg/m2. Girls were on an average 1.4 years older and had almost one unit higher BMI than boys. Underweight was prevalent among almost 38.5% and 25.5% of adolescents as per WHO2007 and national Iranian cut-off points, respectively. The prevalence rates reached 39.5% and 45.8% by IOTF and CDC2000 criteria, respectively. The highest prevalence of overweight was obtained by IOTF cut-points (30.5%), while CDC2000 criteria, WHO2007, and national Iranian cut-points gave similar prevalence results (4.7%, 4.0%, and 4.4%); 2.4% of the studied population were found to be obese by WHO2007 definition, while this rate was 0.8%, 0.5%, and 0.8% by IOTF, CDC2000, and national Iranian cut-points. Conclusion: Almost all definitions revealed coexistence of underweight, overweight, and obesity among Isfahani adolescents. Huge differences exist between different criteria for assessing weight status among children. To understand the best appropriate criteria for Iranian adolescents, future studies should focus on the predictability of obesity related co-morbidities by these criteria. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to compare the nutritional status of pediatric patients with hematological malignancies and solid tumors. Design and Methods A total of 74 pediatric cancer patients were assessed for anthropometric status, biochemical profiles, and dietary intake. Results The prevalence of undernutrition was higher among patients with solid tumors as reflected in their lower dietary intakes of energy and nutrients compared with patients with hematological malignancies. Practice Implication Adequate dietary intake is important for pediatric cancer patients, but nurses need to pay more attention to the diets of patients with solid tumors as compared with those with hematological malignancies. [ABSTRACT FROM AUTHOR]

Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low‐ and middle‐income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)‐sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low‐quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient‐dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding. [ABSTRACT FROM AUTHOR]

Background: The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children's daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children's movement behaviours before and during the COVID-19 pandemic.Methods: Parents of children aged 3-5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined.Results: Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9).Conclusion: PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents' mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines. [ABSTRACT FROM AUTHOR]

Less is known about how compliance with 24‐hour movement guidelines for physical activity (PA), sedentary behavior, and sleep affects adiposity in young people. The purposes of this study were to compare compliance with 24‐hour movement guidelines in Asian adolescents and to examine the associations between compliance with 24‐hour movement guidelines and body fat percentage. A sample of 12 590 adolescents aged 13.63 (± 1.01) years from eight Asian metropolitan cities including Bangkok (Thailand), Hong Kong SAR, Kuala Lumpur (Malaysia), Seoul (South Korea), Shanghai (China), Singapore, Taipei (Taiwan), and Tokyo (Japan) completed interviewer‐administered questionnaires to assess moderate‐to‐vigorous PA, recreational screen time, sleep duration, and covariates. Body fat percentage was measured using bioelectrical impedance analysis. We found that compliance with 24‐hour movement guidelines differed in Asian adolescents across the eight cities. Adjusting for covariates, there was a negative association between number of the guidelines being met and body fat percentage in Asian adolescents. In addition, meeting only the sleep guideline and both the PA and sleep guidelines had negative associations with body fat percentage compared with no guidelines being met. Our findings improve the understanding about how compliance with 24‐hour movement guidelines benefit a healthy body weight in adolescents, as well as contribute to development of evidence‐based 24‐hour movement guidelines for Asian young people. Future research is needed to gain better insights into the directionality of the associations between compliance with 24‐hour movement guidelines and adiposity, as well as the mechanisms underlying the associations in Asian adolescents. [ABSTRACT FROM AUTHOR]

Taste perception is an important determinant of food preference and consumption. Salty taste sensitivity among children can be influenced by ethnicity. This study determined the salty taste threshold among children of different ethnicities in Malaysia. Forty‐two children aged 9–11 years from the three main ethnic groups (14 Malays, 15 Chinese, 13 Indians) in Malaysia were recruited for this cross‐sectional study. The salty taste threshold was determined using two‐alternative forced‐choice staircase with 18 different concentrations of sodium chloride solutions (0.056 to 1,000 mM). Overall, the mean salty taste threshold among children was 1.01 ± 0.71 mM. No significant difference was noted in the salty taste threshold between boys and girls (p =.830). Chinese children had a significantly higher salty taste threshold (1.21 ± 0.53 mM) compared with Malay (1.13 ± 1.13 mM) and Indian children (0.67 ± 0.72 mM, p <.05). In conclusion, further studies are warranted to better understand how taste sensitivity may influence salt preference and food intake among children of different ethnicities in Malaysia. Practical applications: Salty taste sensitivity developed during childhood is one of the factors that influence preference towards salty taste and intake of salty food in later life. A variety of cuisines in different ethnic cultures is related to different preferences in taste and food. The difference of salty taste threshold among children in this study may provide valuable insights and data for future intervention programme among children of different ethnicities. Besides, this study may also provide the foundation and references in the formulation of low salt food. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to investigate and compare physical activity (PA) and health-related fitness in Asian adolescents, and to examine the associations between meeting PA guidelines and attaining fitness standards. Methods: A sample of 12,590 adolescents (Mage = 13.63 years, SD = 1.01) from eight Asian metropolitan cities completed measurements of PA, five field-based fitness tests, and covariates. The fitness test scores were further classified into Healthy Fitness Zone (HFZ) or Needs Improvement Zone (NIZ). Results: Findings showed that adolescents' levels of PA and fitness components differed by cities. City differences were also found in proportions of meeting PA guidelines and achieving the HFZs of aerobic capacity, muscular fitness, and body composition. After controlling covariates, meeting PA guidelines positively associated with being in the HFZs of aerobic and muscular fitness, but the association was not significant with being in the body composition HFZ. Conclusion: There was a large variation in PA and health-related fitness in adolescents across the eight Asian cities. Asian adolescents achieving PA guidelines were more likely to be in the HFZ of aerobic and muscular fitness. Prospective follow-up studies are warranted to gain better insights into the relationships between objectively-measured PA and fitness. [ABSTRACT FROM AUTHOR]

Background: Multiple factors affect growth in children with atopic dermatitis (AD). We investigated food restriction practice, nutrition, and growth in children with AD. Food restriction is defined as restriction ≥3 types of food due to AD or food allergy. Methods: A cross‐sectional study was performed in 150 children aged 12‐36 months. Exclusion criteria: recurrent infections, moderate to severe asthma, recent systemic steroid, other diseases affecting growth/nutrition. Growth parameters, SCORing Atopic Dermatitis (SCORAD), hemoglobin, hematocrit, sodium, potassium, albumin, protein, calcium, phosphate, B12, iron, and folate values were determined. Parents completed a 3‐day food diary. Results: The prevalence of food restriction was 60.7%. Commonly restricted foods were shellfish 62.7%, nuts 53.3%, egg 50%, dairy 29.3%, and cow's milk 28.7%. Food‐restricted children have significantly lower calorie, protein, fat, riboflavin, vitamin B12, calcium, phosphorus and iron intakes and lower serum iron, protein and albumin values. Z scores of weight‐for‐age (−1.38 ± 1.02 vs −0.59 ± 0.96, P =.00), height‐for‐age (−1.34 ± 1.36 vs −0.51 ± 1.22, P =.00), head circumference‐for‐age (−1.37 ± 0.90 vs −0.90 ± 0.81, P =.00), mid‐upper arm circumference (MUAC)‐for‐age (−0.71 ± 0.90 vs −0.22 ± 0.88, P =.00), and BMI‐for‐age (−0.79 ± 1.15 vs −0.42 ± 0.99, P =.04) were significantly lower in food‐restricted compared to non‐food‐restricted children. More food‐restricted children were stunted, underweight with lower head circumference and MUAC. Severe disease was an independent risk factor for food restriction with OR 5.352; 95% CI, 2.26‐12.68. Conclusion: Food restriction is common in children with AD. It is associated with lower Z scores for weight, height, head circumference, MUAC, and BMI. Severe disease is an independent risk factor for food restriction. [ABSTRACT FROM AUTHOR]

Background: Moderate-to-vigorous physical activity (MVPA) and television viewing are independently associated with cardiorespiratory fitness. However, limited evidence is available on their combined effects, specifically of MVPA and watching television, on cardiorespiratory fitness in the young Asian population. Therefore, the present study examined whether MVPA can attenuate the detrimental effects of prolonged television viewing on the cardiorespiratory fitness of Asian adolescents.Methods: This is a cross-sectional study on 9553 adolescents (aged 12-15 years) from 8 Asian metropolitan cities (Tokyo, Hong Kong, Shanghai, Taipei, Bangkok, Kuala Lumpur, Seoul, and Singapore). Cardiorespiratory fitness was assessed by using a 15-m progressive aerobic capacity endurance run (PACER) test. The time spent on MVPA and watching television was assessed using the International Physical Activity Questionnaire-Short Form.Results: MVPA was more closely associated with the PACER score than the duration of watching television. Compared with the reference group (i.e. those with the lowest levels of MVPA [< 30 min/day] and the most sedentary [≥3 h/day of television time]), PACER scores were significantly higher for those who met the physical activity recommendation (≥60 min/day in MVPA), regardless of the duration of television viewing. Conversely, girls in the least active group (< 30 min/day of MVPA) who watched television < 1 h/day demonstrated better PACER scores than the reference group.Conclusions: Sufficient MVPA (≥60 min/day) can attenuate the detrimental effects of excessive television viewing with cardiorespiratory fitness in Asian adolescents. In addition, the duration of television viewing had significant but weaker associations with cardiorespiratory fitness compared to MVPA. [ABSTRACT FROM AUTHOR]

Objective: To compare the contributions of UVB exposure and diet to total vitamin D among Asians living in Kuala Lumpur (KL) and Aberdeen (AB).Design: Longitudinal study.Setting: UVB exposure (using polysulfone film badges) and skin colour and dietary vitamin D intake (by web-based questionnaire) were measured at each season in AB and during south-west (SWM) and north-east monsoons (NEM) in KL.Subjects: One hundred and fifteen Asians in KL and eighty-five Asians in AB aged 20-50 years.Results: Median summer UVB exposure of Asians in AB (0·25 SED/d) was higher than UVB exposure for the KL participants (SWM=0·20 SED/d, P=0·02; NEM= 0·14 SED/d, P<0·01). UVB exposure was the major source of vitamin D in KL year-round (60%) but only during summer in AB (59%). Median dietary vitamin D intake was higher in AB (3·50 µg/d (140 IU/d)), year-round, than in KL (SWM=2·05 µg/d (82 IU/d); NEM=1·83 µg/d (73 IU/d), P<0·01). Median total vitamin D (UVB plus diet) was higher in AB only during summer (8·45 µg/d (338 IU/d)) compared with KL (SWM=6·03 µg/d (241 IU/d), P=0·04; NEM=5·35 µg/d (214 IU/d), P<0·01), with a comparable intake across the full year (AB=5·75 µg/d (230 IU/d); KL=6·15 µg/d (246 IU/d), P=0·78).Conclusions: UVB exposure among Asians in their home country is low. For Asians residing at the northerly latitude of Scotland, acquiring vitamin D needs from UVB exposure alone (except in summer) may be challenging due to low ambient UVB in AB (available only from April to October). [ABSTRACT FROM AUTHOR]

The global prevalence of overweight and obesity among children has increased rapidly in the recent decades, including in Malaysia. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed. This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimed at managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition education programme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits and physical activity level among overweight and obese children. This quasi-experimental study involves two primary schools in Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweight and obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition education classes on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers. The control school does not receive any interventions. The primary outcome is BMI-for-age z-score, while other outcomes include waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentary behaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1 (3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promising approach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment of Parents' and Teachers' Association (PTA). We anticipate that this study may provide insights towards the development of more effective strategies in formulating childhood obesity interventions. [ABSTRACT FROM AUTHOR]

Daily food intake of women may affect their bone health by altering their bone mineral density (BMD) as the lack of certain nutrients may affect bone integrity whilst, BMD also can be a predictor of breast cancer. To date, many studies have been conducted to discuss on association of BMD and mammographic breast density (MBD) and how both are related to breast cancer risks but no consideration has been made on dietary intake. Therefore, this study was designed to determine the association of dietary intake with BMD and other breast cancer risk factors. A cross-sectional study on 76 pre- and postmenopausal women above 40 years underwent mammogram screening and Dual Energy X-ray Absorptiometry (DEXA) was conducted in Hospital Kuala Lumpur (HKL) for the duration of 1 year. Purposive sampling method was used to choose the respondents. Women who are diagnosed with breast cancer and underwent cancer treatment were excluded from this study. DEXA unit (Hologic Discovery W, Hologic, Inc) were used to measure BMD at the femoral neck and lumbar spine in grams per centimetre squared (g/cm2) and they were classified into normal and abnormal group based on the T-scores. The subjects were asked about their daily dietary pattern for a duration of three days using Diet History Questionnaire (DHQ). The mean of selected characteristics were compared between groups. Additionally, binary logistic regression was used to determine the association between diet intake with BMD and other risk factors of breast cancer. The total number of pre- and postmenopausal women who consented to participate in this study are equal. The mean age was 47.1 years and 54.9 years for premenopausal and postmenopausal women respectively. The results indicate only menopausal age of the women was statistically significant (p < 0.05). A number of 17% premenopausal and 9% of postmenopausal women showed to have family history of breast cancer, however, it was not statistically significant (p = 0.12). There was no significant difference in daily energy intake of food in both groups (p = 0.22). None of the nutrients in daily food intake showed to be statistically significant. Menstrual status showed an association with BMD with p < 0.05 and the remaining risk factors did not show any association. Logistic regression revealed that only menstrual status had correlation with BMD in both groups. This study provided the dietary pattern and the effects on bone health. The association of other risk factors of breast cancer with BMD were also analysed and most of it showed a negative association. [ABSTRACT FROM AUTHOR]

The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (>=75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (>=75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Printed educational material is the primary mode of communication in public health education. However, there is a scarcity of studies that evaluate the acceptance towards printed educational materials in Malaysia. Therefore, this study was conducted with the aim of evaluating existing printed nutrition educational materials regarding childhood obesity for use in nutrition education or health promotion programme. This study was conducted in two stages. Stage 1 involved a survey of existing printed nutrition educational materials related to childhood obesity and pilot testing on questionnaires that was developed. Whereas Stage 2 was the evaluation of the acceptance of subjects towards existing printed educational materials and changes in knowledge level after reading the materials. Likert scale from 1 (very not satisfactory) to 5 (very satisfactory) was used in the evaluation. Subjects in this study comprised 67 individuals who were educational and health professionals (n = 7), adults (n = 30) and children (n = 30). In this study, adults were given a booklet that focused on prevention and management of childhood obesity such as complications of childhood obesity and food preparation. Children received a booklet that focused on food pyramid, importance of breakfast, physical activity and so on and a poster that focused on healthy food choices. The professionals were given all three printed materials. This study found that the acceptance of subjects towards content, illustrations, tables and figures, colour, organization of picture, organization of content, language and font size of the three printed educational materials are variety, which ranged from not satisfactory to very satisfactory. Mean satisfaction score of booklet targeted at adult population was 3.9 ± 0.5 while mean satisfaction score of booklet targeted at children population was 4.3 ± 0.4 and poster was 3.9 ± 0.9. Knowledge score of the professionals increased from 88.6 ± 11.2% to 95.5 ± 3.2% after reading the educational materials. The knowledge score of adults also increased significantly (p < 0.001) from 67.7 ± 13.6% to 84.8 ± 15.9%; among children, knowledge score significantly increased (p < 0.001) from 65.3 ± 14.4% to 84.0 ± 11.4%. In conclusion, the existing printed educational materials were well-accepted and were able to increase the knowledge level of target population. Therefore, the printed educational materials are suitable to be used in any health education program related to childhood obesity. [ABSTRACT FROM AUTHOR]

Background: This study examined the effects of bovine colostrum on exercise -induced modulation of antioxidant parameters in skeletal muscle in mice. Adult male BALB/c mice were randomly divided into four groups (control, colostrum alone, exercise and exercise with colostrum) and each group had three subgroups (day 0, 21 and 42). Colostrum groups of mice were given a daily oral supplement of 50 mg/kg body weight of bovine colostrum and the exercise group of mice were made to exercise on the treadmill for 30 minutes per day. Total antioxidants, lipid hydroperoxides, xanthine oxidase and super oxide dismutase level was assayed from the homogenate of hind limb skeletal muscle. Results: Exercise-induced a significant oxidative stress in skeletal muscles as evidenced by the elevated lipid hydroperoxides and xanthine oxidase levels. There was a significant decrease in skeletal muscle total antioxidants and superoxide dismutase levels. Daily colostrum supplement significantly reduced the lipid hydroperoxides and xanthine oxidase enzyme level and increased the total antioxidant levels in the leg muscle. Conclusion: Thus, the findings of this study showed that daily bovine colostrum supplementation was beneficial to skeletal muscle to reduce the oxidant-induced damage during muscular exercise. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]