Associations between Personality Traits and Body Weight Status with Energy Intake of Adolescents in Hulu Langat District, Malaysia

Personality traits are divided into five basic dimensions: extraversion, neuroticism, conscientiousness, agreeableness and openness. These influence our attitudes and behaviours. Studies show that differences in personality traits may influence the dietary intake. Methods: A cross-sectional study aimed at determining the association between personality traits and body weight status with energy intake was conducted among adolescents in Hulu Langat district of Selangor. Height, weight and waist circumference were measured and respondents completed a pre-tested self-administered questionnaire. Personality traits were assessed using the Malay version of USM Personality (USMaP-i). A single 24-h dietary recall was used to assess dietary intake. Results: A total of 430 adolescents aged 13-16 years (46% male and 54% female) was recruited. Female respondents tended to be more neurotic and agreeable compared to male respondents. A majority of the respondents (67%) were in the normal weight category, 26.7% were overweight and obese, while 19.0% had a high risk of developing abdominal obesity with a mean waist circumference of 72.65 ± 10.93cm. Males significantly had a higher intake of energy (1425±583 kcal), compared to females (1232±462 kcal). Conscientiousness trait (r=-0.158, p<0.01), BMI-for-age (r=-0.147, p<0.01) and waist circumference (r=-0.108, p<0.05) were inversely related to the energy intake of the respondents. Conclusion: Leaner adolescents and individuals with low conscientiousness were significantly consuming more energy than their counterparts. Understanding the personality traits that may regulate caloric intake is essential in order to develop effective interventions towards modifying obesity-inducing eating patterns.

Prevalence of Malnutrition and its Association with Socio-demographic Characteristics among Malaysian Adolescents Living in Day-school Hostels

Introduction: The life of an adolescent in a school hostel is well-managed with respect to daily food intake and physical activity. These adolescents are likely to be physically active and are assumed to consume nutritious food. However, little is known about malnutrition and factors related to it. Thus, this study determined the association between malnutrition (thinness & overweight) and socio-demographic characteristics of these adolescents living in day-school hostels. Methods: Data from Program Cara Hidup Sihat (Healthy Lifestyle Program), comprising a total of 4189 13-year-old school-going adolescents were used. A multi-stage stratified cluster sampling method was applied. Information on socio-demographic characteristics was collected using self-administered questionnaires. Body weights and heights were measured. Body mass index (BMI)-for-age (z-score), or BAZ, was determined using the World Health Organization's (WHO) Growth Reference. Results: The prevalence of overweight (23.3%, 95% CI: 22.1, 24.7) was about six times higher than thinness (4.3%, 95% CI: 3.7, 5.0). Males had higher prevalence of thinness (5.6%, 95% CI: 4.6, 6.9) compared to females (3.4%, 95% CI: 3.7, 4.2). A higher prevalence of overweight was observed in the central zone than in the other five zones. Complex samples logistic regression showed that adolescents from the central zone and those with monthly parental incomes a RM 5000 were 2.5 times (adjusted odds ratio [OR]=2.5, 95% confidence interval [CI]: 1.6, 3.9) and 2.0 times (adjusted OR=2.0, 95% CI: 1.3, 2.9), respectively, more likely to be at risk of overweight compared to adolescents from the other five zones and with parents whose monthly incomes were less than RM 5000. Conversely, male adolescents were 1.7 times more likely to be at risk of thinness (adjusted OR=1.7, 95% CI: 1.2, 2.3) compared to female adolescents. Conclusion: The dual forms of malnutrition co-existed, with over-nutrition being more prevalent than under-nutrition. Future healthy body weight intervention programs should consider sex, monthly parental incomes and geographic zones of adolescents living in day-school hostels.

Association of Body Weight Status and Socio-Demographic Factors with Food Habits among Preschool Children in Peninsular Malaysia

Introduction: Changes in children's food habits are largely attributed to changes in the family and social environment. This cross-sectional study was carried out to determine the association of socio-demographic factors with food habits among preschool children in Peninsular Malaysia. Methods: A total of 1,933 preschool children aged 4-6 years old participated in the study. Parents or guardians were interviewed on the socio-demographic characteristics and food habits of their children. Height and weight of the preschoolers were measured; BMI-for-age, weight-for-age and height-for-age were determined. Results: The mean monthly household income was RM3,610 with 59.6% of parents having attained secondary education. The prevalence of possible risk of overweight, being overweight and obesity were 3.9%, 7.9% and 8.1%, respectively while the prevalence of underweight and stunting was 8.0% and 8.4%. A majority of the preschoolers consumed breakfast, lunch and dinner every day, with the proportion of children skipping their main meals at about 15.0%. Parents' education level and household income were significantly associated with intakes of fruits, vegetables, milk and dairy products, as well as fast food. However, there was no significant association between children's body weight status and frequency of main meals intake, fruits, vegetables, milk and dairy products, and fast food intake. Conclusion: The preschoolers demonstrated moderately healthy food habits; nevertheless even at this young age, they were inclined towards fried foods, snacking and fast foods intake. Parents and guardians should play a more significant role in educating and promoting good nutrition and food habits among preschoolers.

A Randomised Controlled Trial of a Facebook-based Physical Activity Intervention for Government Employees with Metabolic Syndrome

Introduction: This study aimed to ascertain the effects of a Facebook-based physical activity intervention on improvements in step counts and metabolic syndrome. Methods: Government employees with metabolic syndrome were randomly assigned by cluster to the Facebook group (n = 44) or the control group (n = 103). All participants were asked to complete self-administered questionnaires at baseline, after the first and second phases. Data from anthropometric (weight, body mass index, fat mass, body fat percentage, waist circumference, hip circumference and waist-to-hip ratio), biochemical (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and fasting glucose) and clinical examinations (systolic blood pressure and diastolic blood pressure) were collected. The number of steps per day was determined by a Lifecorder e- STEP accelerometer. Results: A significant difference in the number of steps per day between the baseline and the first phase (p<0.001) was observed in both the Facebook and control groups. A significant group main effect (p<0.001) was found for the number of steps per day; the Facebook group had a significantly greater increase in the number of steps per day than the control group. Overall, a significant strong to very strong correlation was found between the changes in the number of steps per day and the changes in the other variables. Conclusion: The Facebook-based intervention approach has the potential to increase physical activity among government employees with metabolic syndrome.

Factors Associated with Breakfast Skipping among School-going Adolescents in Sarawak, Malaysia

Introduction: Breakfast skipping is an unhealthy eating behaviour reportedly common among adolescents. A cross-sectional study was carried out to determine the differences in body weight status, socio-demographic, behavioural, and psychological characteristics between daily breakfast takers and breakfast skippers. Methods: Data were collected from form four students of four randomly selected secondary schools in Sibu, Sarawak using a self-administered questionnaire. Body weight and height were measured using standard procedures and BMI-for-age z-scores were determined. Results: A total of 375 students were recruited (male: 32.0%, female: 68.0%; Chinese: 39.5%, than: 26.4%, Malay: 17.1% and Melanau: 17.1%; mean age = 16.45 � 0.53 years). The prevalence rate of breakfast skippers at 40.3% was higher compared to the national prevalence of 32.7%. About 19.7% of the students were found to be at risk of eating disorders. In addition, the prevalence rates of overweight and obesity were 10.9% and 7.7%, respectively. Significant associations were found between breakfast skipping with sex, lunch skipping, dinner skipping, eating attitudes, and body weight status. Binary logistic regression analysis showed that female students and those who skipped lunch or dinner were more likely to skip breakfast. Conclusion: Breakfast skipping was quite common in this sample of adolescents in Sarawak. As frequent breakfast skipping has negative health and academic performance implications, increased nutrition education and health awareness campaigns on the importance of breakfast taking among school students should be undertaken.

Validity and Reliability of the Multidimensional Body Image Scale in Malaysian University Students

Introduction: This study aimed to evaluate the validity and reliability of the Multidimensional Body Image Scale (MBIS), a seven-factor, 62-item scale developed for Malaysian female adolescents. This scale was evaluated among male and female Malaysian university students. Methods: A total of 671 university students (52.2% women and 47.8% men) completed a self-administered questionnaire on MBIS, Eating Attitude Test-26, and Rosenberg Self-Esteem Scale. Their height and weight were measured. Results: Results in confirmatory factor analysis showed that the 62-item MBIS reported poor fit to the data, ²/df = 4.126, p < 0.001, CFI = 0.808, SRMR = 0.070, RMSEA = 0.068 (90% CI = 0.067, 0.070). After re-specification of the model, the model fit was improved with 46 items remaining, ²/df = 3.346, p < 0.001, CFI = 0.903, SRMR = 0.053, RMSEA = 0.059 (90% CI = 0.057, 0.061), and the model showed good fit to the data for men and women separately. This 46-item MBIS had good internal consistency in both men (Cronbach’s alpha = 0.88) and women (Cronbach’s alpha = 0.92). In terms of construct validity, it showed positive correlations with disordered eating and body weight status, but negative correlation with self-esteem. Also, this scale discriminated well between participants with and without disordered eating. Conclusion: The MBIS-46 demonstrated good reliability and validity for the evaluation of body image among university students. Further studies need to be conducted to confirm the validation results of the 46-item MBIS.

Accelerometer-Determined Physical Activity Level among Government Employees in Penang, Malaysia

Introduction: A cross-sectional study was carried out to investigate accelerometerdetermined physical activity level of 233 Malay government employees (104 men, 129 women) working in the Federal Government Building Penang,Malaysia. Methods: Body weight, height, waist and hip circumference, body fat percentage and blood pressure were measured for each respondent. All the respondents were asked to wear an accelerometer for 3 days. Body mass index (BMI) and waist-hip ratio (WHR) were calculated using a standard formulas. Fasting blood sample was obtained to determine the lipid profile and glucose levels of the respondents. Results: Based on the accelerometer-determined physical activity level, almost 65% of the respondents were categorised as sedentary. Approximately 50.2% of the respondents were overweight or obese. There were negative but significant relationships between body mass index (BMI) (r=-0.353, p<0.05), body fat percentage (r=-0.394, p<0.05), waist circumference (WC) (r=-0.198, p<0.05) and physical activity level. Sedentary individuals had a higher risk than moderate to active individuals of having a BMI more than or equal to 25 kg/m2 (OR= 2.80, 95% CI 1.55-5.05), an-risk classified WC (OR= 1.79, 95% CI 1.01-3.20), and a body fat percentage classified as unhealthy (OR= 3.01, 95% CI 1.41-6.44). Conclusion: The results of this study suggest that accelerometer-determined physical activity level is a significant factor associated with obesity in this study. The high prevalence of physical inactivity and obesity found among respondents of this study indicate a need for implementing intervention programmes among this population.

Nutritional Status of Children Living with HIV and Receiving Antiretroviral (ARV) Medication in the Klang Valley, Malaysia

Introduction: Nutrition and HIV are closely related. Any immune impairment as a result of HIV leads to malnutrition, which in turn, can also lead to reduced immunity, thus contributing to a more rapid progression to AIDS. Methods: This cross-sectional study determined the nutritional status of children living with HIV and are receiving antiretroviral medication in the Klang Valley. A total of 95 children aged one to eighteen years old were recruited between September 2008 and February 2009. Data collected included socio-economic status, anthropometric measurements, dietary intake, medical history and serum levels of selected micronutrients specific for immunity. Results: The mean age of the children was 8.4±3.9 years and the mean duration on antiretroviral medications was 68.3±38.3 months. Anthropometric assessment found that 9.5% of the children were underweight and 31.6% were overweight. In contrast, 20.8% were stunted and 14.6% severely stunted. Biochemical indicators showed that 10.4% had deficiency in vitamin A while 12.5% had deficiency in selenium. Total cholesterol and HDL-C levels were found to be low in 30.5% and 10.5% of the children respectively. Conclusion: Dietary assessment showed almost all the children did not achieve the recommended energy intake for their age groups and almost half of the children did not achieve the RNI for selenium and vitamin A. This study provides an insight on the nutritional status of children living with HIV.

Differences in Eating Behaviours, Dietary Intake and Body Weight Status between Male and Female Malaysian University Students

Introduction: University students are potentially important targets for the promotion of healthy lifestyles as this may reduce the risks of lifestyle-related disorders later in life. This cross-sectional study examined differences in eating behaviours, dietary intake, weight status, and body composition between male and female university students. Methodology: A total of 584 students (59.4% females and 40.6% males) aged 20.6±1.4 years from four Malaysian universities in the Klang Valley participated in this study. Participants completed the Eating Behaviours Questionnaire and two-day 24-hour dietary recall. Body weight, height, waist circumference and percentage of body fat were measured. Results: About 14.3% of males and 22.4% of females were underweight, while 14.0% of males and 12.3% of females were overweight and obese. A majority of the participants (73.8% males and 74.6% females) skipped at least one meal daily in the past seven days. Breakfast was the most frequently skipped meal. Both males and females frequently snacked during morning tea time. Fruits and biscuits were the most frequently consumed snack items. More than half of the participants did not meet the Malaysian Recommended Nutrient Intake (RNI) for energy, vitamin C, thiamine, riboflavin, niacin, iron (females only), and calcium. Significantly more males than females achieved the RNI levels for energy, protein and iron intakes. Conclusion: This study highlights the presence of unhealthy eating behaviours, inadequate nutrient intake, and a high prevalence of underweight among university students. Energy and nutrient intakes differed between the sexes. Therefore, promoting healthy eating among young adults is crucial to achieve a healthy nutritional status.

Determination of Factors Associated with Physical Activity Levels among Adolescents Attending School in Kuantan, Malaysia

Introduction: Findings from the National Health and Morbidity Survey III (MOH, 2008) indicate a 43.7% prevalence of physical inactivity among Malaysian adults. This sedentary lifestyle can also be observed among children and adolescents. Methodology: A cross-sectional study was conducted to determine factors associated with physical activity levels of four hundred, 13 year-old adolescents in Kuantan, Pahang. Data on socio-demographic, health-related, and psychosocial factors were collected using a self-administered questionnaire while physical activity level was assessed using the Physical Activity Questionnaire for Older Children (PAQ-C). Results: About one-third of the respondents were in the low physical activity level category, 61.5% were in the moderate category and only 3.0% of the adolescents were in the high physical activity level category. Males were more physically active than females (χ2=23.667, p=0.0001) with female adolescents (45.1%) twice as likely as male adolescents (22.1%) to be in the low physical activity level category. The associations between physical activity level with socio-demographic and health-related factors, perception of weight status and body parts satisfaction were not significant. However, physical activity was found to be positively correlated with physical activity self-efficacy (r=0.496, p=0.0001), peer influence (r=0.468, p=0.0001), family influence (r=0.298, p=0.0001) and beliefs in physical activity outcomes (r=0.207, p=0.0001). Negative relationships were found between physical activity with depression (r=-0.116, p=0.021) and body size discrepancy (r=-0.143, p<0.01). Respondents who had a better perception of their current health status were more physically active (χ2=21.062, p=0.0001). Multivariate analyses for the prediction of physical activity showed that physical activity self-efficacy, sex and peer influence were the most significant contributors in explaining physical activity among adolescents. Conclusion: Physical activity interventions should include psychosocial components as mediator variables in interventions designed to promote regular physical activity in adolescence.

Familial and Socio-environmental Predictors of Overweight and Obesity among Primary Scholl Children in Selangor and Kuala Lumpur

Introduction: A cross-sectional study was conducted to determine the familial and socio-environmental predictors of overweight and obesity among 1430, 9- 12 year-old primary school children and their parents in Selangor and Kuala Lumpur. Methodology: Body weight and height were measured and body mass index was calculated. Modified Child Feeding (CFQ) and Determinants of Adolescent Social Well-being and Health (DASH) questionnaires were used to measure familial and socio-environmental factors. Results: A total of 17.9% of the children were overweight while 16.0% were obese. Positive relationships were found between child’s BMI and parent’s BMI (r = 0.129, p < 0.01), concern about child’s weight (r = 0.125, p < 0.01) and restriction (r = 0.057, p < 0.05) to unhealthy foods. However, negative relationships were found between child’s BMI with pressure to eat (r = -0.135, p < 0.01) and neighbourhood safety perception (r = -0.053, p < 0.05). The logistic regression analysis showed that being male (Exp (β) = 0.538; 95% CI = 0.421-0.687), higher parent’s BMI (Exp (β) = 1.055; 95% CI = 1.028-1.082), higher concern about child’s weight (Exp (β) = 1.082; 95% CI = 1.030- 1.127), low pressure to eat (Exp (β) = 0.857; 95% CI = 0.801-0.916) and low perception of neighbourhood safety (Exp (β) = 0.951; 95% CI = 0.913-0.990) were significantly associated with increased risk of overweight. Conclusion: Parents should be the main target for education to modify children’s weight status. Further research should be carried out to understand the mechanism of influence of parents and the socio-environment on child’s health.

Physical Activity, Eating Behaviour and Body Image Perception among Young Adolescents in Kuantan, Pahang, Malaysia

Introduction: A cross-sectional study was conducted to determine physical activity, eating behaviour, body weight management knowledge, perception of body image and their association with body weight status of adolescents. Methods: Respondents were 360 adolescents, aged between 13 to 14 years, from six randomly selected secondary schools in Kuantan, Pahang. Physical activity, eating behaviour, body weight management knowledge and perception of body image were measured by the Physical Activity Questionnaire for Older Children (PAQ-C), Eating Attitude Test-26 (EAT-26), Weight Management Knowledge Inventory (WMKI) and Contour Drawing Rating Scale (CDRS), respectively. Results: Almost half of the respondents were categorised as having a normal BMI, while 30.3% were severely thin and thin and 20.3% were overweight and obese. Mean physical activity score was 2.06+0.45 with more males (35.0%) being physically active than females (17.3%). Mean eating behaviour score was 15.41+10.37, with 27.8% of the respondents being at-risk for eating disorders. Mean weight management knowledge score was 5.35+1.80, with more females (77.7%) having higher mean scores than males (42.3%). Further, mean discrepancy score for body image perception was 1.24+0.99, with 78.1% of the respondents being dissatisfied with their current body size. Positive associations were found between eating behaviour (r=0.28, p<0.05) and body image (r=0.35, p<0.05) with BMI. Respondents with high eating behaviour scores and body image discrepancy scores were more likely to have greater BMI. Conclusion: This study shows the need for healthy eating and body image intervention programmes to prevent overweight and obesity problems among adolescents.

Socio-Demographic and Psychosocial Factors Associatedwith Physical Activity of Working Woman in Petaling Jaya, Malaysia

Introduction: This study was conducted on 215 working women from four private corporate companies in a suburb in Malaysia to determine the factors related to their physical activity levels. Methods: Data were collected using a questionnaire which included socio-demographic characteristics, the International Physical Activity Questionnaire (IPAQ), perceived barriers and benefits to physical activity, self-efficacy to physical activity and an 8-item questionnaire on current behavioral stage of physical activity. Results: The majority of the respondents were Malay (81.9%) with 10.2% being Chinese and 7.9% Indian. Most of the respondents were executives (64.2%), while the rest were non-executives (24.7%) and managers (11.2%). The mean weight, height, BMI and waist circumference were 59.4±13.1 kg, 1.6±0.6 m, 23.7±4.8 kg/m² and 77.0±12.1cm respectively. In this sample, 24.7% and 7.9% were overweight and obese respectively, while 34% were at risk of abdominal obesity. A total of 28.8% of the respondents had low physical activity level, while 48.8% and 22.3% were in the moderate and high physical activity categories respectively. An association was found between monthly income (χ2=110.17; p0.05). Physical activity category was also positively correlated with perceived barriers (r=0.227, p<0.05) and benefits to physical activity (r=0.280, p<0.05). However, physical activity was not associated with self-efficacy to physical activity. Conclusion: In this sample of working women, socio-demographic and psychosocial factors (except self-efficacy to physical activity) were found to have an association with physical activity level of the respondents. Further studies should be conducted to confirm these findings in the general working women population.

Sex and ethnic differentials in physical activity levels of adolescents in Kuantan

A cross-sectional study was conducted to determine the physical activity levels of 400 adolescents (13 years old) in Kuantan, Pahang using the Physical Activity Questionnaire for Older Children (PAQ-C). The associations of physical activity levels with sex, ethnicity and body mass index were also determined. About one third (35.3%) of the adolescents were in the low physical activity level category, 61.5% in the moderate physical activity level and only 3.0% of the adolescents were in the high physical activity level category. More males (77.9%) were physically active than females (54.9%). Twice as many female adolescents (45.1%) were in the low physical activity level category compared to the male adolescents (22.1%). The associations between physical activity with ethnicity and body mass index were not significant. However, there was a significant interaction effect of sex and ethnicity in mean physical activity score (F = 2.36, p<0.01). Malay males had a significantly higher mean physical activity score as compared to Chinese males (t=2.13; p<0.05). Although Chinese females had a higher mean physical activity score than Malay females, the difference was not statistically significant. Conversely, there was no interaction effect of sex and BMI status in mean physical activity score. This study suggests that physical activity intervention to promote regular physical activity is needed since a high proportion of the adolescents fall within the low physical activity level category.