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@#Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.
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@#Introduction: Designing an effective and comprehensive weight reduction intervention requires an understanding of the motivating factors and barriers to losing weight. This study explored the motivating factors and barriers to weight reduction through the experiences, emotions and ideas shared among suburban overweight and obese Malay adults. Methods: In this qualitative study, 23 overweight or obese Malay adults aged 30-59 years old were divided into three focus group discussion (FGD). The Socio-Ecological Model (SEM), consisting of four levels (intrapersonal, interpersonal, community, and policy) was utilised in this study. Results: The motivating factors were: (1) Intrapersonal level: self-awareness, health concern, self-confidence, and desire to have good physical appearance, (2) Interpersonal level: social support from family and friends, (3) Community level: availability and accessibility of physical activity facilities and health information, and (4) Policy level: healthy lifestyle programme. The barriers were: (1) Intrapersonal level: lack of knowledge about diet, physical limitations, lack of self-control, and emotion/mood, (2) Interpersonal level: spouse and children, career or housework commitment, (3) Community level: lack of neighbourhood safety, and availability and accessibility of outside foods, and (4) Policy level: availability and accessibility of outside foods. Conclusion: Eight factors were identified as motivating factors and barriers for weight reduction practices. Support from family and friends should be considered when developing an effective and comprehensive weight loss programme as it was both a motivating factor as well as a barrier.
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@#Introduction: The refeeding programme in government hospitals is aimed at improving the nutritional status of malnourished children with weight-for-height z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of data on the nutritional status of indigenous (Orang Asli) children when they return to the community after hospital discharge. Case Presentation: A 3-year-old Temiar boy residing in a tribal village in Hulu Perak was visited to determine his nutritional status following discharge from a refeeding programme in a government hospital. He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ –2.91. Discussion: The management of the case in the hospital was based on the Malnourished Orang Asli Protocols of the hospital. Household food insecurity, feeding and care practices, unhealthy household environment and the lack of communication between hospital and community health services were all identified as risk factors for malnutrition. Conclusion: The recurrence of malnutrition in this child, after successful improvement during hospital stay, highlights the importance of identifying factors that may affect nutritional status after hospital discharge. This knowledge will be beneficial in planning specific interventions, especially for Orang Asli children, living in remote villages
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The global prevalence of overweight and obesity among children has increased rapidly in the recent decades, includingin 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 aimedat managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition educationprogramme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits andphysical activity level among overweight and obese children. This quasi-experimental study involves two primary schoolsin Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweightand obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition educationclasses 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 outcomesinclude waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentarybehaviour 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 promisingapproach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment ofParents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development ofmore effective strategies in formulating childhood obesity interventions.
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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.
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Pediatric Obesity , Receptor, InsulinABSTRACT
Objectives: Vitamin D insufficiency is endemic in western countries. Emerging evidence suggests this may be true also for countries with abundant sunshine. This study aimed to evaluate the vitamin D status and associated risk factors in a sub-sample of children from the South East Asian Nutrition Surveys (SEANUTS). Methods: SEANUTS was conducted in Indonesia, Malaysia, Thailand and Vietnam in a country representative sample of 16744 children aged 0.5 to 12 years. Information on socio-demographic variables, lifestyle habits and anthropometric measures were collected. In a sub-sample of 2016 children, serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Results: In Malaysia and Thailand, urban children had lower 25(OH)D levels than rural children. Except Vietnam, boys in all countries had higher 25(OH)D levels and older children had lower 25(OH)D levels. Regional differences persisted in all countries even after correcting for age, sex and area of residence. In Malaysia and Thailand, 25(OH)D status was also associated with religion. The percentage of children with adequate 25(OH)D levels (>75nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50nmol/L) was noted in nearly 40% to 50% of children in all countries. Girls, urban area, region and religion significantly increased the odds of being vitamin D insufficient. Conclusions: The high prevalence of vitamin D insufficiency in SEANUTS countries suggests a need for a tailored approach to successfully combat this problem. Promoting active and outdoor lifestyle along with food fortification can be feasible options.
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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. 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. 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 (=ρ0.55 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). The IPAQ-M has acceptable validity for MVPA, vigorous and total physical activity, and was reliable for assessing the physical activity of Malay adults.
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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 fi gures, 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 signifi cantly (p < 0.001) from 67.7 ± 13.6% to 84.8 ± 15.9%; among children, knowledge score signifi cantly 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
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Caffeine had been shown to have an ergogenic effect on trained individuals; however, studies investigating the physiological effects of caffeine on the sedentary population are limited. The aim of this study was to examine the effect of caffeine on oxygen consumption and rating of perceived exertion during moderate intensity exercise among sedentary young adult females. Subjects comprised 16 female undergraduates aged between 22 to 24 years studying at Universiti Kebangsaan Malaysia. Eligibility criteria were based on low physical activity level and daily caffeine intake of less than 50 mg a day, which was screened using the International Physical Activity Questionnaire (short version) and caffeine consumption questionnaire, respectively. The design of this study is single-blind, crossover, placebo-controlled with all subjects serving as their own controls. Subjects were required to report to the physical activity laboratory for two experimental sessions after either ingesting placebo or caffeine capsule with an interval of 3 days between these two experimental sessions. Sixty minutes after ingesting placebo capsule (Glucolin, glucose) or 100 mg caffeine (Pro-plus, United Kingdom), subjects were required to run on a treadmill for 30 minutes at a standardized power output equivalent to 60% of maximal heart rate. Oxygen consumption, heart rate, and rating of perceived exertion were recorded at 20th, 25th and 30th minutes, while blood pressure was recorded immediately after subjects completed their 30 minutes run. Mean body fat percentage was 28.4 ± 5.4. Differences were recorded after every subject completed both the placebo and caffeine experiments. Paired t-tests showed no significant difference between placebo vs caffeine trials for oxygen consumption (13.99 ± 2.47 vs 14.49 ± 1.73, p = 0.440), rating of perceived exertion (12.3 ± 2.5 vs 12.3 ± 2.1, p = 1.000), systolic blood pressure (113 ± 10 vs 117 ± 11, p = 0.129), diastolic blood pressure (67 ± 8 vs 69 ± 10, p = 0.408) and heart rate (127.3 ± 11.0 vs 127.1 ± 11.6, p = 0.912). There was strong significant negative correlation between body fat percentage and oxygen consumption (r = –0.568, p < 0.05) and strong significant positive correlation between body fat percentage and rating of perceived exertion (r = 0.515, p < 0.05). The non-significance in the results obtained could be due to the small effect size of the study (d = 0.24). Hence, future studies with a larger number of participants should be carried out to examine the effects of caffeine during exercise in a sedentary population
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Malnutrition can be associated as one of the factors which affect health status. The term is used to describe imbalance of nutrients either over- or under-nourished, resulting in measurable adverse effects on body composition, function and clinical outcome. The National Health And Morbidity Survey (NHMS) 2011 assessed 4304 individuals aged 10-17 years old through a household survey of Malaysian population. Thinness and obesity are the malnutrition indicators based on Centre for Disease Control (CDC) 2000 classification as recommended by WHO (2007). The findings of the survey showed that the national prevalence of thinness (BMI for age <-2SD), was 9.7% (95% Confidence Interval: 8.4-11.2). The state of Sabah/Labuan had the highest thinness of prevalence, 17.0% (11.1-25.2) and lowest in Penang at 5.3% (2.7-10.0). The prevalence of thinness was higher in urban areas than in rural areas at 10.3% (8.5-12.3). Meanwhile; national prevalence of obesity (BMI for age ≥+2SD) was only 5.7% (4.9-6.7). The state of Perak had the highest obesity prevalence 10.0% (6.2-15.8) and lowest in Sabah/Labuan at 2.4% (1.4-4.1). The obesity prevalence was higher among adolescents in urban areas at 6.3% (5.2-7.6) than in rural areas. Thinness as a form of malnutrition is more prevalent than obesity. Even though the prevalence of obesity is low, the impact affects not only the adolescents, but also the family, the society and the nation in the future. The increasing prevalence of obesity will have significant public health implication related to non-communicable diseases.