Birth Cohort Consortium of Asia: Current and Future Perspectives.

BACKGROUND: The environmental health of children is one of the great global health concerns. Exposures in utero and throughout development can have major consequences on later health. However, environmental risks or disease burdens vary from region to region. Birth cohort studies are ideal for investigating different environmental risks. METHODS: The principal investigators of three birth cohorts in Asia including the Taiwan Birth Panel Study (TBPS), the Mothers and Children's Environmental Health Study (MOCEH), and the Hokkaido Study on Environment and Children' Health (Hokkaido Study) coestablished the Birth Cohort Consortium of Asia (BiCCA) in 2011. Through a series of five PI meetings, the enrolment criteria, aim of the consortium, and a first-phase inventory were confirmed. RESULTS: To date, 23 birth cohorts have been established in 10 Asian countries, consisting of approximately 70,000 study subjects in the BiCCA. This article provides the study framework, environmental exposure and health outcome assessments, as well as maternal and infant characteristics of the participating cohorts. CONCLUSIONS: The BiCCA provides a unique and reliable source of birth cohort information in Asian countries. Further scientific cooperation is ongoing to identify specific regional environmental threats and improve the health of children in Asia.

Consumption of ready-to-eat cereals (RTEC) among Malaysian children and association with socio-demographics and nutrient intakes - findings from the MyBreakfast study.

Background: The association between different types of breakfast meals and nutrient intakes has been studied to a lesser extent. Objective: This study compared nutrient intakes at breakfast and throughout the day between Malaysian children who consumed ready-to-eat cereals (RTEC) and those who did not. Methods: Anthropometric and dietary data for 1955 children aged 6-12 years from the MyBreakfast study were used in the analysis. Results: Overall, 18% of the children consumed RTEC at breakfast on at least one of the recall days. RTEC consumption was associated with younger age, urban areas, higher income and education level of parents. Among consumers, RTEC contributed 10% and 15% to daily intakes of calcium and iron respectively and ≥20% to daily intakes of vitamin C, thiamin, riboflavin and niacin. RTEC consumers had significantly higher mean intakes of vitamin C, thiamin, riboflavin, niacin, calcium, iron and sugar but lower intakes of fat and sodium than non-RTEC consumers at breakfast and for the total day. Conclusion: Consumption of fortified RTEC at breakfast was associated with lower fat and sodium intakes and higher intakes of several micronutrients both at breakfast and for the total day. However, total sugar intakes appeared to be higher.

Association of parental body mass index before pregnancy on infant growth and body composition: Evidence from a pregnancy cohort study in Malaysia.

BACKGROUND AND OBJECTIVES: Parental body mass index (BMI) is strongly linked with the development of offspring overweight and obesity. However, there are a limited number of studies focusing on the association of parental body mass index before pregnancy on offspring growth and body composition in early life, particularly in developing countries. METHODS: Data from the University Sains Malaysia (USM) Pregnancy Cohort which consists of 153 mother-offspring pairs were used. Data were collected using interview-administered questionnaires and anthropometric measurements were also obtained. Multiple linear regression and generalised equation estimation (GEE) were used to examine the direction and impact of the association between parental BMI and child growth and body composition (weight for age, height for age, body mass index for age, weight for height and fat mass at age 2m, 6m, and 12m). Potential confounders, including validated measures of maternal diets and physical activity during pregnancy, were considered. RESULTS: Of 153 parents, one-quarter of the mothers and 42.2% of the fathers, respectively, were overweight or obese before pregnancy. A significant association was found between maternal BMI and child's weight for height z-score (WHZ) and body mass index for age z-score (BAZ). CONCLUSIONS: Having high pre-pregnancy BMI may increase BMI and WAZ of offspring in early life. Findings from this study emphasise the importance of monitoring maternal weight status, particularly before and during pregnancy and early life of offspring among Malaysians.

Characteristics associated with the consumption of malted drinks among Malaysian primary school children: findings from the MyBreakfast study.

BACKGROUND: The consumption of beverages contributes to diet quality and overall nutrition. Studies on malted drinks, one of the widely consumed beverage choices among children in Asia, however, have received limited attention. This study aimed to examine the prevalence of malted drink consumption and explored associations of sociodemographic characteristics, nutrient intakes, weight status and physical activity levels with malted drink consumption among primary school children in Malaysia. METHODS: Data for this analysis were from the MyBreakfast Study, a national cross-sectional study conducted from April to October 2013 throughout all regions in Malaysia. A total of 2065 primary school children aged 6 to 12 years were included in the present analysis. Data on two days 24-h dietary recall or record, anthropometry, physical activity and screen time were recorded. Associations between malted drink consumption and related factors were examined using binary logistic regression, adjusting for region, area, gender, ethnicity and household income. RESULTS: Among children aged 6 to 12 years, 73.5% reported consuming malted drinks for at least once per week. Consumption of malted drinks was significantly associated with region (χ(2) = 45.64, p < 0.001), gender (χ(2) = 4.41, p = 0.036) and ethnicity (χ(2) = 13.74, p = 0.008). Malted drink consumers had similar total energy intake but higher micronutrient intakes compared to non-consumers. High physical activity level (OR = 1.77, 95% CI = 1.06, 2.99) and lower screen time during weekends (OR = 0.93, 95% CI = 0.86, 0.99) were independently associated with malted drink consumption among 6 to 9 year-old children, but not among 10 to 12 year-old children. No association was observed between malted drink consumption and weight status. CONCLUSIONS: Malted drink consumption is prevalent among Malaysian primary school children, particularly higher among boys, indigenous children and those who lived in the East Coast region of Malaysia. Consuming malted drinks is associated with higher micronutrient intakes and higher levels of physical activity, but not with body weight status.

Prevalence and determinants of overweight, obesity, and type 2 diabetes mellitus in adults in Malaysia.

This systematic review aimed to examine trends in overweight, obesity, and type 2 diabetes mellitus (T2DM) among Malaysian adults, and to identify its underlying determinants. A review of studies published between 2000 and 2012 on overweight, obesity, and T2DM was conducted. The Cochrane library of systematic reviews, MEDLINE, EMBASE, Biosis, Scopus, and MyJurnal digital database were searched. According to national studies, the prevalence of overweight increased from 26.7% in 2003 to 29.4% in 2011; obesity prevalence increased from 12.2% in 2003 to 15.1% in 2011, and T2DM prevalence was reported as 11.6% in 2006 and 15.2% in 2011. Distal determinants of increased risk of overweight, obesity, and T2DM were as follows: female, Malay/Indian ethnicity, and low educational level. The limited number of studies on proximal determinants of these noncommunicable diseases (NCDs) indicated that an unhealthy diet was associated with increased risk, whereas smoking was associated with decreased risk. However, more studies on the proximal determinants of overweight, obesity, and T2DM within the Malaysian context are needed. Overall, our findings provide insights for designing both future investigative studies and strategies to control and prevent these NCDs in Malaysia.

Effect of ethnicity, dietary intake and physical activity on plasma adiponectin concentrations among malaysian patients with type 2 diabetes mellitus.

BACKGROUND: The Malaysian Health and morbidity Survey (2006) reported the highest prevalence of type 2 diabetes mellitus (T2DM) among the Indian population compared to the Malay and Chinese populations. Many studies have supported the important role of adiponectin in insulin-sensitizing, which is associated with T2DM. These studies have raised a research question whether the variation in prevalence is related to the adiponectin concentrations or the lifestyle factors. OBJECTIVES: The purpose of this study is to determine whether the adiponectin concentrations differ between the Malay, Chinese and the Indian populations with T2DM. It is to investigate the association of adiponectin concentrations with ethnicity, dietary intake and physical activity too. MATERIALS AND METHODS: In this cross-sectional study, a total of 210 T2DM patients with mean (SD) age of 56.73 (10.23) years were recruited from Penang, Malaysia. Data on demographic background, medical history, anthropometry (weight, height, visceral fat, percentage of body fat and waist circumference), dietary intake (3 days 24 hours diet recall) and physical activity (International Physical Activity Questionnaire) were obtained accordingly. Plasma adiponectin and routine laboratory tests (fasting blood sugar, HbA1c, total cholesterol, LDL, HDL and triglyceride) were performed according to standard procedure. RESULTS: After adjustment for physical activity and dietary intakes, the Indian population had significantly lower adiponectin concentrations (P = 0.003) when compared with the Malay and the Chinese populations, The Indian population also had significantly higher value of HbA1c (P = 0.017) and significantly lower HDL (P = 0.013). Plasma adiponectin concentrations was significantly associated with ethnicity (P = 0.011), dietary carbohydrate (P = 0.003) and physical activity total MET score (P = 0.026), after medical history, age, sex, total cholesterol and visceral fat adjusted. However, dietary carbohydrate and physical activity did not show significantly difference among the various ethnic groups. CONCLUSIONS: In conclusion, lower concentration of adiponectin in the Indian population when compared with the Malay and the Chinese populations is not associated with lifestyle factors. The possibility of adiponectin gene polymorphism should be discussed further.

Women are at a higher risk of metabolic syndrome in rural Malaysia.

Metabolic syndrome has been associated with an increased risk of cardiovascular disease and diabetes mellitus. The objective of this study was to determine gender differences in the prevalence and factors associated with metabolic syndrome in a rural Malay population. This cross-sectional study, conducted in Bachok, Kelantan, involved 306 respondents aged 18 to 70 years. The survey used a structured questionnaire to collect information on demographics, lifestyle, and medical history. Anthropometric measurements, such as weight, height, body mass index, waist and hip circumference, and blood pressure were measured. Venous blood samples were taken by a doctor or nurses and analyzed for lipid profile and fasting glucose. The overall prevalence of metabolic syndrome was 37.5% and was higher among females (42.9%). Being unemployed or a housewife and being of older age were independently associated with metabolic syndrome in a multivariate analysis. Weight management and preventive community-based programs involving housewives, the unemployed, and adults of poor education must be reinforced to prevent and manage metabolic syndrome effectively in adults.

Relative validity of dietary patterns during pregnancy assessed with a food frequency questionnaire.

This study aimed to assess the relative validity of maternal dietary patterns derived from a semi-quantitative food frequency questionnaire (FFQ). A total of 162 pregnant women aged 19-40-years-old were enrolled from the Universiti Sains Malaysia (USM) Birth Cohort Study in year 2010 and 2011. The FFQ was compared with three 24-h dietary recalls (DRs). Two major dietary patterns were derived from the principle component analysis which are labeled as Healthy and Less-Healthy patterns. The Pearson correlation coefficients between FFQ and DRs for Healthy and Less-Healthy patterns were 0.59 and 0.63, respectively. At least 45% of the participants were correctly classified into the same third from the FFQ and DR for both dietary patterns. The weighted kappa showed moderate agreement for Healthy pattern while good agreement for Less-Healthy pattern between these two dietary assessment methods. Our results indicate reasonable validity of the dietary patterns identified from the FFQ in pregnant women.

Iron requirements based upon iron absorption tests are poorly predicted by haematological indices in patients with inactive inflammatory bowel disease.

Fe deficiency and Fe-deficiency anaemia are common in patients with inflammatory bowel disease (IBD). Traditional clinical markers of Fe status can be skewed in the presence of inflammation, meaning that a patient's Fe status can be misinterpreted. Additionally, Fe absorption is known to be down-regulated in patients with active IBD. However, whether this is the case for quiescent or mildly active disease has not been formally assessed. The present study aimed to investigate the relationship between Fe absorption, Fe requirements and standard haematological indices in IBD patients without active disease. A group of twenty-nine patients with quiescent or mildly active IBD and twenty-eight control subjects undertook an Fe absorption test that measured sequential rises in serum Fe over 4 h following ingestion of 200 mg ferrous sulphate. At baseline, serum Fe, transferrin saturation, non-transferrin-bound Fe (NTBI), ferritin and soluble transferrin receptor were all measured. Thereafter (30-240 min), only serum Fe and NTBI were measured. Fe absorption did not differ between the two groups (P = 0·9; repeated-measures ANOVA). In control subjects, baseline haematological parameters predicted Fe absorption (i.e. Fe requirements), but this was not the case for patients with IBD. Fe absorption is normal in quiescent or mildly active IBD patients but standard haematological parameters do not accurately predict Fe requirements.