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@#Aims: The purpose of this review is to evaluate the social media intervention’s efficacy, as well as the intervention’s theory, model, and framework. Design: Systematic review. Data sources: Five databases- PubMed, Web of Sciences, Scopus, Science Direct and Google Scholar were searched systematically from June 18 to July 12, 2022. Methods: Predefined keywords of “social media”, “nutrition”, “behaviour” and “adolescents” were used. The inclusion criteria: (1) 10 to 24 years old participants; (2) social media or website as intervention platform; (3) intervention outcomes related to improvement in nutrition behaviour, anthropometric measures, knowledge and awareness; (4) is a randomized controlled trial, non-randomized controlled trial, cluster controlled, cohort, case control or before and after study design; (5) published in 2000 until 2022; (6) written or translated is English; and (7) conducted in Asia. Results: Review eligibility included nine studies. Three research were web- or website-based, while the other six used social media such as Facebook, WhatsApp, and LINE. Post-intervention outcomes showed significant gains, however some studies found no differences between the intervention and control groups. Conclusion: Social media is a widely accepted platform for educating adolescents about nutrition for behaviour change. However, the evidence shows that the interventions are lack of significant improvement between groups and the used of digital or technological-related theory, model and framework. This review demonstrated the progress of healthy behaviours in nutrition and health literacy among adolescents that can be spread through social network and the value of new technological techniques in managing the targeted population.
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@#Introduction: Increased consumption of sugar-sweetened beverages (SSBs) is strongly associated with weight gain, dental cavities, and a higher risk of chronic diseases among adolescents. However, there is no available FFQ for the Malaysian population individually to evaluate and assess the consumption of SSBs and high-energy dense (HED) foods among adolescents. Method: A 24-hour diet recall with 30 adolescents were performed via Google Meet to identify the most common and frequent types of SSBs and HEDs foods consumed nowadays. The food checklist of SSBs and HED foods from literature review search was also provided to the participants. Experts critically reviewed each food item and provide a score for its relevancy and essentiality. Face validity were conducted among 10 adolescents to validate the developed FFQ. Results: The final FFQ consisted of 63 food items with ten categories. This FFQ showed high content validity for individual items with I-CVI ranging from 0.67 to 1.00 and overall questionnaires with S-CVI/Ave valued at 0.97. The calculation of Kappa statistic showed that this newly developed FFQ has excellent inter-rater reliability at the item level with K > 0.74 for 55 items and K = 0.57 only for 4 items. Most of the items were marked as relevant with a CVR score of 1.00. Conclusion: The findings of this study imply that the newly developed FFQ could be utilised to estimate the intake of SSB and HED foods of Malaysian adolescents.
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@#Introduction: The increasing prevalence of overweight and obesity has been alarming. One approach to address this issue is to implement health promotion programmes. Despite the many health promotion and health intervention programmes held, there is a lack of evidence showing the application of theories and models. This scoping review aimed to explore existing literature and synthesise findings based on models and theories used to support health promotion programmes for overweight and obese adults. Methods: This review was guided by the Arksey and O’Malley framework. Online databases, such as Ovid, PubMed, Scopus, and Web of Science, were used to search for relevant articles using suitable keywords, from January 2015 until December 2021. Articles were written in English and Malay, and the study subjects were adults aged 18-59 years old. Two reviewers independently screened the articles, and the extracted information were tabulated after analysis. Results: A total of 13 different theories and models were found in the 27 articles selected. Many studies reported using the Transtheoretical Model, Social Cognitive Theory, and Health Belief Model in health promotion programmes for overweight and obese adults. Most constructs and components focused on changing health-related behaviours starting with the individual, such as self-efficacy and readiness to change. Majority of the articles showed an improvement in health-related behaviours and had great potential for future studies. Conclusion: When conducting health promotion programmes for overweight and obese adults, researchers should consider models and theories with constructs and components to ensure consistent improvement and potentially significant impacts on health-related outcomes.
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@#Introduction: Adolescent health is a priority considering they represent the future generation. Data from the Adolescent Nutrition Survey 2017 were analysed to determine the prevalence of micronutrient inadequacy, particularly calcium and iron, and the relationship with body mass index (BMI) among Malaysian secondary school students. Methods: This cross-sectional study included students aged 13 to 17 years old studying at public and private schools. Twenty-four hours dietary recall via face-to-face interview was conducted by trained nutritionists to obtain data on dietary intake. For nutritional status, BMI-for-age z-score (BAZ) was analysed using WHO Anthroplus software. Results: From 999 respondents, 449 were boys and 550 were girls. Overall findings indicated that both boys and girls had inadequate intakes of calcium and iron in their daily diet. Mean intakes of calcium (695.7±463.2 mg/day) and iron (23.4±21.0 mg/day) were higher among boys aged 16 to 17 years old. Mean intake of iron were higher among the older age groups. Majority of the respondents (boys: 94%; girls: 97%) did not meet the recommended nutrient intake (RNI) for calcium and more than half (boys: 50%; girl: 80%) did not achieve the RNI for iron. Current findings also found significant positive but weak correlations between calcium (r=0.112, p=0.001) and iron (r=0.084, p=0.008) intakes with BMI-for-age. Conclusion: BMI-for-age was related to calcium and iron intakes among secondary school students in Malaysia. Thus, intervention strategies should focus on early screening and nutrition education on food choices of high calcium and high iron contents, including iron supplementation programmes, if needed.
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@#Introduction: Many people are seeking knowledge and skills about preparing healthy meals at home. This study aimed to determine the content of nutrients in 60 healthy dishes prepared for the recipe book Mudah, Sihat, Sedap used in the F.E.A.T nutrition intervention programme. The recipe book was developed as an educational material to guide participants in preparing healthy meals at home. Methods: A needs assessment survey was done to identify food preferences for breakfast, lunch and dinner of obese and overweight respondents. Recipes for these foods were then modified to reduce the calorie, fat, and sugar contents, while adding in fibre sources. Proximate analysis was done based on standard methods of AOAC, while total carbohydrate and calorie contents were calculated using the differentiation and Atwater methods, respectively. Mineral content was determined using atomic absorption spectrophotometer, while fatty acids content was analysed by gas chromatography using the FAME method. Results: Proximate analysis results showed that Kobis Goreng had the most calories (305 kcal/100g) (p<0.05) in all categories. Mineral analysis showed that sodium was significantly highest (p<0.05) in Asam Pedas Daging (554 mg/100g). For fatty acid analysis, Masak Lemak Telur Itik had the highest amount of MUFA (45.1%), Masak Lemak Sotong had the highest amount for SFA (71.8%), and Masak Lemak Cili Api Udang had the highest amount of PUFA (33.7%). Conclusion: This study successfully modified original recipes of selected cuisines used in the recipe book, which contained lower calories compared to original recipes. The calorie and nutrient values for each recipe will be included as nutrition composition information in the recipe book.
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@#Obesity among school children has now reached an alarming level in most developing countries, including Malaysia. Thus, numerous strategies to curb the rising of obesity focusing on school children have been taking place. However, this issue management is complex, and a holistic approach is needed to address it comprehensively. This scoping review aimed to identify the characteristics of obesity interventions conducted among school children in Malaysia as a principal recommendation to develop a comprehensive obesity intervention. Arksey and O'Malley’s framework used to guide the scoping review process. Published articles on intervention studies conducted for school children in Malaysia from 2007 to 2020 retrieved based on keyword using the selected electronic and local databases. The NVivo 12 Plus software used to place findings in the systematic framework matric form and evidence tables. The final results reported in descriptive tables. Eighteen studies only reviewed among 3417 extracted articles. Thirteen aspects of the characteristics of the interventions identified. The influence of environmental intervention (family and school communities) on children lifestyle identified as a research gap. Combined environmental interventions and educational guides with technology application recognised as one of the potential components for future obesity intervention design amongst school 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 culture of eating out among Malaysians has substantially increased in recent years due to the urbanisation of the society. Frequent eating out has been linked with reduced quality of diet, reduced intake of micronutrients, and increased weight gain. This study aims to explore specific factors on the perceptions and behaviours related to eating out from the perspective of parents. Methods: A qualitative study was carried out among 27 informants from various ethnicities and locations in Peninsular Malaysia. All sessions were audio-recorded, fully transcribed and analysed using thematic content analysis. Results: The main overarching theme that surfaced from this study was the role of parents in shaping the practice of eating out. Time constraints due to parents’ work commitments, the availability of various food outlets, increase in family bonding time and food preferences were recurring themes revealed by informants as facilitating factors to eating out. Other emerging themes, such as hygiene of food premises and cost of food, posed as barriers to eating out. Conclusion: These findings offered a better understanding on the eating out practices of a family from the parents’ perspective. Information as such could be incorporated in strategies to enhance the promotion of healthy eating and nutrition interventions that aim to inculcate healthy food choices while eating out.
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@#Behavioural change interventions for weight loss have been found to be effective in the short term, but their long-term effectiveness remains a question. The objective of this study was to evaluate the effectiveness of the 36 weeks F.E.A.T program combining behavioural changes of healthy eating and physical activity. A quasi-experimental study of overweight adults was conducted in Malacca. A total of 53 subjects (mean age 47.4 ± 7.2 years) completed the program in three stages. In the first stage (T1: weeks 1–12), the intervention group (n = 28) participated in the F.E.A.T program activities, while the control group (n = 25) did not receive the intervention. In the second stage (T2: weeks 13-24), the activity was supervised and monitored by the peer support group. Sustainability of activity was measured at the third stage (T3: weeks 25-36). The effectiveness of the program was measured by changes in dietary intake, physical activity score, body weight, body mass index (BMI), waist circumference (WC) and body fat percentage at T0 (pre-intervention), T1, T2 and T3. All parameters showed significant interaction effects (time*group) except for energy intake. The intervention group showed significant decreases from T0 to T3 for energy intake (-14.3%), body weight (-4.3%), BMI (-4.2%), WC (-10.5%) and body fat percentage (-3.6%). While physical activity level increased by 109.6% for the intervention group. There were no significant differences in all of these parameters among the control group. The results show the effectiveness of the F.E.A.T program on dietary status and physical activity changes during the 36-week of intervention period.
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@# Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels. Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software. Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information. Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.
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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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Background: Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur. Methods: In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24-hour dietary recalls) were obtained. Results: Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs. Conclusion: The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.
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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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White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/ L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.