Association between dietary pattern and Helicobacter Pylori infection at Queen Elizabeth Hospital, Kota Kinabalu: A case-control study.

BACKGROUND: Limited studies have reported the association between dietary patterns and Helicobacter pylori (H. pylori) infection in Sabah. OBJECTIVE: The purpose of this study was to assess the association between dietary pattern and H. pylori infection among patients aged 18 years and above that went for first esophagogastroduodenoscopy (OGDS) in 2021 at Queen Elizabeth Hospital (QEH), Kota Kinabalu. METHODS: Dietary intake of positive H. pylori was compared with healthy subjects by using questionnaire adapted from Malaysian Adult Nutrition Survey (MANS) 2014. Using logistic regression models, we evaluated the association between dietary pattern and H. pylori infection risk. FINDINGS: Our finding identified four dietary patterns, namely "high carbohydrate pattern", "high fiber pattern", "high fat/cholesterol pattern" and "high salt pattern". After adjustment for potential confounders, the highest quartile of "high salt pattern" showed greater odds of H. pylori infection (OR = 1.26; 95% Cl: 1.032-1.459; P = 0.045) than lowest quartile, while highest quartile of "high fiber pattern" demonstrated lower odd of the infection (OR = 0.69; 95% Cl: 0.537-0.829; P = 0.008) than those in lowest quartile. If compared with Recommended Nutrient Intake (RNI) 2017, positive H. pylori consumed high carbohydrates and sodium with insufficient fiber intake. CONCLUSION: To conclude, "high fiber pattern" lowers the risk of H. pylori infection while "high salt pattern" increases the infection risk. Our study also highlighted the importance of nutrient intake within daily allowances.

Problematic Gaming in Malaysian University Students: Translation and Psychometric Evaluation of the Malay Language Versions of Gaming Disorder Test and Gaming Disorder Scale for Young Adults.

As research on gaming disorder (GD) is growing globally, the need for a valid and reliable instrument to assess GD has become crucial. Therefore, the present cross-sectional study translated and evaluated the psychometric properties of Gaming Disorder Test (GDT) and Gaming Disorder Scale for Young Adults (GADIS-YA) into Malay language versions. The sample comprised 624 university students (females = 75.6%; mean age = 22.27 years) recruited via an online survey from May to August 2022, using a convenience sampling method. Participants completed both GDT and GADIS-YA scales and other relevant measures including Bergen Social Media Addiction Scale (BSMAS), Internet Gaming Disorder Scale-Short Form (IGDS9-SF), and time spent on social media and gaming. Results showed that both instruments reported satisfactory internal consistency, and confirmatory factor analysis supported the one-factor structure for GDT and two-factor structure for GADIS-YA. Both scales were strongly correlated with each other and with the IGDS9-SF, BSMAS, and time spent on social media and gaming, supporting concurrent validity. Measurement invariance of both scales was confirmed across gender and gaming time. These findings suggest that the Malay versions of GDT and GADIS-YA are reliable and valid measures of problematic gaming among Malaysian university students.

Seasonality, food security, diet quality and nutritional status in urban poor adolescents in Malaysia.

Seasonality was shown to have an effect on food availability and accessibility, increasing the risk of food insecurity and causing poor diet quality and malnutrition. Therefore, this study aimed to determine seasonal effects on household food security status, diet quality, and nutritional status of urban poor adolescents in Malaysia. A cohort study was conducted among 164 adolescents aged 10-17 from 12 People Housing Programme in Kuala Lumpur, Malaysia during the Northeast (November 2021 till March 2022) and Southwest (June 2022 till September 2022) monsoon. Household food security status was measured using the 18-item USDA Household Food Security Survey Module. Dietary intake was determined using a two-days 24-h dietary recall and translated into Standardized Malaysian Healthy Eating Index (S-MHEI). Anthropometric and haemoglobin level measurements were performed to determine nutritional status. Seasonality was found to have a significant effect on overall diet quality (p = 0.021), food groups such as fish (p < 0.001), meat/poultry/eggs (p = 0.003), and legumes/nuts (p < 0.001), and fat nutrient (p = 0.037) as well as anaemia status (p = 0.020) after controlling the confounders. Although food security did not vary with seasons, seasonality affected the consumption of certain food groups as well as anaemia status for urban poor adolescents. Seasonally sensitive nutrition initiatives should be developed to ensure diet adherence to recommendations, ultimately enhancing the diet quality of urban poor adolescents.

Association between maternal anemia and stunting in infants and children aged 0-60 months: A systematic literature review.

OBJECTIVES: Maternal anemia is a worldwide health issue and a common pregnancy complication. It leads to consequences including infant mortality, low birth weight, preterm birth, unrecoverable or partially reversible neurobehavioral and cognitive deficits, and short birth length. However, the relationship between maternal anemia and stunting in children is not well defined. This systematic literature review sought to determine whether maternal anemia was associated with height or length and stunting conditions in infants and children ages 0-60 mo in cohort, case-control, and cross-sectional studies carried out in several countries. METHODS: A systematic review was performed on articles published from 2014-2021 related to maternal anemia and stunting. The electronic databases used were ScienceDirect, PubMed, Scopus, ProQuest, Google Search, and AJOG (American Journal of Obstetrics and Gynecology). The literature search was performed up to December 7, 2021. RESULTS: Twelve studies were included. Nine studies examined the correlation between maternal anemia and length or weight in children. Seven of the nine studies showed an association between maternal anemia and stunting in children; the others showed an association between maternal anemia and birth length. Three studies found no association between maternal anemia and stunting in children under age 5 y. CONCLUSIONS: The current review emphasizes that stunting in children may be associated with maternal anemia, specifically in developing countries. This implies that it is crucial to prevent anemia in adolescent girls and women before and during pregnancy as a part of programs to eliminate stunting in children.

Food security and diet quality among urban poor adolescents in Kuala Lumpur, Malaysia.

BACKGROUND/OBJECTIVES: This study aimed to examine the food security status of urban poor adolescents and its association with diet quality. SUBJECTS/METHODS: A cross-sectional survey was conducted among 188 adolescents aged 13-18 yrs living in Kuala Lumpur, Malaysia. Household food insecurity and dietary intake data were collected using the Radimer/Cornell hunger and food insecurity instrument and 2-day 24-h dietary recalls, respectively. Diet quality was determined using the Malaysian Healthy Eating Index (HEI). Weight and height were measured and body mass index-for-age, as well as height-for-age z scores were calculated. RESULTS: The present study revealed that 47.9% of the adolescents experienced household food insecurity, 24.5% experienced individual food insecurity, 18.6% household food security, and 9.0% child hunger. The mean score of diet quality was 56.83 ± 10.09, with a significantly lower HEI score among food insecure adolescents (household food insecure, individual food insecure, and child hunger) than household food secure adolescents (P = 0.001). The differences between food secure and food insecure households were found to be significant for energy (P = 0.001) and nutrients including proteins (P = 0.006), carbohydrates (P = 0.005), dietary fiber (P = 0.001), folate (P < 0.001), and vitamin C (P = 0.006). The multiple linear regression showed that adolescents who experienced food insecurity (ß = -0.328; P = 0.003) were found to be significantly associated with poor diet quality (F = 2.726; P < 0.01), wherein 13.3% of the variation in the diet quality was explained by the food security status. CONCLUSIONS: Experiencing food insecurity contributed to poor diet quality among urban poor adolescents. Further longitudinal studies are needed to comprehensively understand this association to improve food insecurity and diet quality among urban poor communities.

Seasonal variation in food security, lifestyle, nutritional status and its associated factors of the urban poor adolescents in Kuala Lumpur, Malaysia: research protocol of a prospective cohort study.

BACKGROUND: Climate change, obesity and undernutrition have now become a worldwide syndemic that threatens most people's health and natural systems in the twenty-first century. Adolescent malnutrition appears to be a matter of concern in Malaysia, and this is particularly relevant among the urban poor population. Mounting evidence points to the fact that underlying factors of malnutrition are subject to climate variability and profoundly affect nutritional outcomes. Hence, it is interesting to examine seasonal variation in nutritional status and its associated factors of urban poor adolescents in Malaysia. METHODS: This is a prospective cohort study following urban poor adolescents aged 10-17 years living in low-cost high-rise flats in Kuala Lumpur, Malaysia, across two monsoon seasons. The baseline assessment will be conducted during the onset of the Northeast Monsoon and followed up during Southwest Monsoon. Climate data will be collected by obtaining the climatological data (rainfall, temperature, and relative humidity) from Malaysia Meteorological Department. Geospatial data for food accessibility and availability, and also built (recreational facilities) environments, will be analyzed using the QGIS 3.4 Madeira software. Information on socio-demographic data, food security, lifestyle (diet and physical activity), and neighbourhood environment (food and built environment) will be collected using a self-administrative questionnaire. Anthropometric measurements, including weight, height, and waist circumference, will be conducted following WHO standardized protocol. WHO Anthro Plus was used to determine the height-for-age (HAZ) and BMI-for-age (BAZ). Anaemic status through biochemical analyses will be taken using HemoCue 201+® haemoglobinometer. DISCUSSION: The study will provide insights into the seasonal effects in nutritional status and its associated factors of urban poor adolescents. These findings can be useful for relevant stakeholders, including policymakers and the government sector, in seizing context-specific strategies and policy opportunities that are seasonally sensitive, effective, and sustainable in addressing multiple challenges to combat all forms of malnutrition, especially among urban poor communities. TRIAL REGISTRATION: The protocol for this review has not been registered.

A home gardening intervention to improve vegetable consumption among urban poor children: A study protocol for randomised controlled trial.

Background: One of the key importance of vegetable consumption is to obtain sufficient micronutrients, dietary fibre, and for the prevention of childhood obesity. Most Malaysian children did not meet the recommended intake of vegetable consumption, and this is especially vulnerable among the urban poor population due to food insecurity. Efforts are needed to promote vegetable consumption that fall short of the recommended intake level. Aim: This trial aims to examine the effectiveness of the "GrowEat" project, as a nutrition intervention programme integrated with home gardening activities to improve vegetable consumption among urban poor children in Kuala Lumpur, Malaysia. Methods: This is a single-blinded parallel two-arm cluster randomised controlled trial (RCT) that include 134 children. Two zones in Kuala Lumpur will be randomly selected, and three low-cost housing flats from each zone will be selected as the intervention and control groups respectively. The trial is designed based on the social cognitive theory (SCT). Children from the intervention group (n = 67) will attend a 12-week programme, which consists of home garden-based activities, gardening and nutrition education session. Assessment will be conducted for both groups at three time points: baseline, post-intervention and follow-up phase at 3 months after the intervention. Conclusion: We anticipate positive changes in vegetable consumption and its related factors after the implementation of the "GrowEat" project. The current intervention may also serve as a model and can be extended to other urban poor population for similar interventions in the future to improve vegetable consumption, agriculture and nutrition awareness.

Problematic Use of Internet Among Indonesia University Students: Psychometric Evaluation of Bergen Social Media Addiction Scale and Internet Gaming Disorder Scale-Short Form.

OBJECTIVE: Social media addiction and internet gaming disorder may cause mental health problems among a minority of university students. The Bergen Social Media Addiction Scale (BSMAS) and the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) are commonly used worldwide. However, they have not been translated or validated into Indonesian. The present study aimed to translate and validate the BSMAS and IGDS9-SF in an Indonesian context among young adults. METHODS: A multi-center, web-based cross-sectional study was conducted among 458 university students (74% female; mean age 22.5 years) in Indonesia from June to December 2021. The BSMAS and IGDS9-SF were translated into Indonesian. Internal consistency (using Cronbach's α and McDonald's ω) and factor structure (using confirmatory factor analysis) of the two instruments were examined. Concurrent validity of BSMAS and IGDS9-SF was examined using their correlations with two external concepts: nomophobia and psychological distress. RESULTS: Internal consistency of the Indonesian BSMAS and IGDS9-SF were both acceptable (Cronbach's α=0.80 and 0.90; McDonald's ω=0.86 and 0.92). Both instruments were unidimensional with good factor loadings (0.54-0.78 for BSMAS; 0.63-0.79 for IGDS9-SF). Moreover, BSMAS and IGDS9-SF had stronger associations with nomophobia (r=0.58 and 0.12; p<0.001) than with psychological distress (r=0.43 and 0.15; p<0.001). CONCLUSION: The Indonesian versions of the BSMAS and IGDS9-SF had good psychometric properties in terms of linguistic validity, unidimensionality, and reliability. The findings indicate the tools are appropriate for assessing the risk of social media addiction and internet gaming disorder among university students in Indonesia.

Functional Food Consumption and Its Associated Factors among University Students in Malaysia during COVID-19 Pandemic.

Background: In the current situation of COVID-19, dietary intake that incorporates functional foods may potentially be a preventive measure for defence against viral infection. This study aimed to determine the consumption of functional foods and its associated factors among university students during COVID-19. Methods: This was a cross-sectional study conducted among 284 Malaysian university students in Kuala Lumpur, Malaysia. An online self-administered questionnaire was employed to assess subjects' nutrition knowledge, dietary habits, attitude towards functional foods, recognition and consumption of functional food products. Results: Out of 284 respondents, 41.9% had poor level of nutrition knowledge and 57% had moderate level of functional food-related attitude, with seven types of functional foods consumed on average (57.0%). Binary logistic regression showed that university students who consumed fruits at least three times per day (aOR = 11.18; 95% CI: 1.46, 80.17), salty snacks (aOR = 2.90; 95% CI: 1.43, 5.86), soft drinks/sugar-sweetened beverages (SSB) (aOR = 3.12; 95% CI: 1.53, 5.26) and pure juice (aOR = 2.80; 95% CI: 1.48, 5.30) were more likely to consume functional foods during COVID-19 (P < 0.05). Conclusion: The findings could provide information to public and private sectors in terms of creating a supportive environment to encourage and promote the awareness and consumption of functional foods and their associated health benefits.

Weight Stigma among Young Adults in Thailand: Reliability, Validation, and Measurement Invariance of the Thai-Translated Weight Self Stigma Questionnaire and Perceived Weight Stigma Scale.

The previous studies found that the Weight Self Stigma Questionnaire (WSSQ) and Perceived Weight Stigma Scale (PWSS) have shown well-established psychometric properties for measuring weight stigma with strong reliability and validity from different languages. However, there is a lack of an appropriate instrument in assessing weight stigma in Thai samples. This study aimed to examine the Thai WSSQ and PWSS among Thai university students. Both instruments were also assessed for their measurement invariance across gender and weight status subgroups. A cross-sectional study was conducted on 801 university students in Thailand between January 2022 and July 2022. All participants completed a demographic questionnaire and a Thai version of the WSSQ, PWSS, and Depression Anxiety Stress Scale-21 (DASS-21) via an online survey. Reliability, validity, measurement invariance, and correlational analyses were performed to investigate whether the Thai versions of the WSSQ and PWSS psychometric properties were acceptable. Both translated questionnaires demonstrated overall acceptable psychometric properties and revealed a two-dimensional structure for the WSSQ, and unidimensional structure for the PWSS. Measurement invariance was obtained across gender and weight status subgroups. Additionally, both translated WSSQ and PWSS were significantly correlated with DASS-21. The Thai-translated WSSQ and PWSS showed strong validity, reliability, and factorial invariance across different subgroups for measuring weight stigma among Thai university students.

The Yale Food Addiction Scale 2.0 and the modified Yale Food Addiction Scale 2.0 in Taiwan: Factor structure and concurrent validity.

Introduction: The most widely used instruments to assess food addiction - the Yale Food Addiction Scale 2.0 (YFAS 2.0) and its modified version (mYFAS 2.0) - have not been validated in a Taiwanese population. The present study compared the psychometric properties between the Taiwan versions of YFAS 2.0 and mYFAS 2.0 among university students. Methods: An online survey comprising the YFAS 2.0, mYFAS 2.0, Weight Self-Stigma Questionnaire (WSSQ) and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used to assess food addiction, self-stigma, and physical activity. Results: All participants (n = 687; mean age = 24.00 years [SD ± 4.48 years]; 407 females [59.2%]) completed the entire survey at baseline and then completed the YFAS 2.0 and mYFAS 2.0 again three months later. The results of confirmatory factor analysis (CFA) indicated that the YFAS 2.0 and mYFAS 2.0 both shared a similar single-factor solution. In addition, both the YFAS 2.0 and mYFAS 2.0 reported good internal consistency (Cronbach's α = 0.90 and 0.89), good test-retest reliability (ICC = 0.71 and 0.69), and good concurrent validity with the total scores being strongly associated with the WSSQ (r = 0.54 and 0.57; p < 0.01), and less strongly associated with BMI (r = 0.17 and 0.13; p < 0.01) and IPAQ-SF (r = 0.23 and 0.25; p < 0.01). Discussion: Based on the findings, the Taiwan versions of the YFAS 2.0 and mYFAS 2.0 appear to be valid and reliable instruments assessing food addiction.

Yale Food Addiction Scale 2.0 (YFAS 2.0) and modified YFAS 2.0 (mYFAS 2.0): Rasch analysis and differential item functioning.

BACKGROUND: Food addiction (FA) is a prevalent concern that may manifest as poorly controlled food consumption and promote overweight/obesity. Thus, having a well-established instrument for assessment may facilitate better prevention and treatment. The current study investigated the psychometric properties of two common measures of FA (i.e., the Yale Food Addiction Scale [YFAS] 2.0 and its modified version, mYFAS 2.0) using a robust statistical analysis (Rasch model). METHODS: In this cross-sectional study, the scales were sent to 974 students studying in higher education (60% females) in Taiwan through online media including email and social networks. Rasch modeling was used to assess dimensionality, difficulty level, and item misfit and hierarchy. Differential item functioning (DIF) was performed to examine consistency of the items across gender and weight status. RESULTS: Rasch analysis indicated 3 items of the 35 items belonging to the YFAS 2.0 (8.6%) and none belonging to the mYFAS 2.0 were misfit. Unidimensionality and construct validity of both scales were supported by appropriate goodness-of-fit for diagnostic criteria. The person separation was 3.14 (reliability = 0.91) for the YFAS 2.0 and 2.17 (reliability = 0.82) for mYFAS 2.0, indicating the scales could distinguish participants into more than 3 strata. Only one substantial DIF was found for diagnostic criteria of "Failure to fulfill major role obligation" in the YFAS 2.0 across gender. CONCLUSION: According to Rasch modeling, both the YFAS 2.0 and mYFAS 2.0 have acceptable construct validity in Chinese-speaking youth. Scoring methods using either diagnostic criteria or symptom counts for both the YFAS 2.0 and mYFAS 2.0 are supported by the present Rasch findings.

Food addiction is related to eating disorders and may overlap with a variety of disorders, including binge-eating disorder, night-eating syndrome, bulimia nervosa or other conditions. Therefore, it is important for healthcare providers to assess food addiction and one commonly used method is using the Yale Food Addiction Scale (YFAS) developed by Gearhardt and her colleagues. The YFAS has been updated and revised into two versions: the YFAS 2.0 and modified YFAS 2.0 (i.e., mYFAS 2.0). Psychometric testing studies have reported the feasibility and adequate properties for both the YFAS 2.0 and mYFAS 2.0. However, prior studies' findings were based on classical test theory (CTT) findings. The present study thus used a modern test theory (i.e., Rasch models) to examine if both the YFAS 2.0 and mYFAS 2.0 have similarly satisfactory psychometric properties shown in the CTT findings. The present findings using Rasch models support the use of both the YFAS 2.0 and mYFAS 2.0 to assess food addiction among youth. Therefore, healthcare providers may use either the YFAS 2.0 or mYFAS 2.0 to assess levels of food addiction.

Associations of Problematic Internet Use, Weight-Related Self-Stigma, and Nomophobia with Physical Activity: Findings from Mainland China, Taiwan, and Malaysia.

Insufficient physical activity is a common problem for university students because they may engage in sedentary lifestyle owing to excessive time spent on their smartphones and social media use. This may result in problematic internet use (PIU) and nomophobia (fear of not having a mobile phone). Moreover, prior evidence shows that weight-related self-stigma is an important factor contributing to low physical activity. Therefore, the present study examined the associations between PIU, nomophobia, and physical activity among university students across mainland China, Taiwan, and Malaysia. Participants (3135 mainland Chinese, 600 Taiwanese, and 622 Malaysian) completed the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), Nomophobia Questionnaire (NMPQ), Weight Self-Stigma Questionnaire (WSSQ), and International Physical Activity Questionnaire Short Form (IPAQ-SF). The measurement invariance of the assessed questionnaires was supported across the three regions. The present findings analyzed using partial least squares structural equation modeling showed that (i) greater nomophobia was associated with higher levels of physical activity, (ii) greater weight-related self-stigma was associated with higher levels of physical activity, and (iii) greater nomophobia was associated with greater weight-related self-stigma. Although the present findings suggest the possibility that experiencing some level of nomophobia or weight-related self-stigma appears to help improve physical activity, it is not recommended that these be encouraged, but reducing PIU should be targeted as a means to improve physical activity.

Internet-Related Instruments (Bergen Social Media Addiction Scale, Smartphone Application-Based Addiction Scale, Internet Gaming Disorder Scale-Short Form, and Nomophobia Questionnaire) and Their Associations with Distress among Malaysian University Students.

The present study evaluated the psychometric properties of four instruments related to internet use, namely the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), (nine-item) Internet Gaming Disorder Scale Short Form (IGDS9-SF), and Nomophobia Questionnaire (NMPQ) as well as their associations with psychological distress among Malaysian university students. A total of 380 Malaysian university students (71.6% females, mean age 24.0 years) were recruited through convenience sampling and completed an online survey including questions concerning socio-demographic background, social media addiction, smartphone addiction, internet gaming disorder, and nomophobia. Confirmatory factor analysis and Rasch analysis were applied to evaluate the psychometric properties of the instruments and Cronbach's alpha value and McDonald's omega value were used to confirm the internal consistency reliability of the instruments. The unidimensional structure was confirmed for the BSMAS, SABAS, and IGDS9-SF while the four-factor structure was confirmed for NMPQ. All instruments showed good internal consistency reliability. Promising validity and reliability were confirmed for BSMAS, SABAS, IGDS9-SF, and NMPQ. Therefore, they are useful to assess different types of problematic internet use among university students in Malaysia. Furthermore, a significant association was observed between internet use and psychological distress. The present study is the first to investigate the validity and reliability of BSMAS, SABAS, IGDS9-SF, and NMPQ among Malaysian university students using rigorous psychometric testing methods (i.e., Rasch analysis).

Knowledge and practices in preventing nutritional anaemia of the urban poor adolescents in Kuala Lumpur, Malaysia.

Background: Anaemia has been identified as a major public health problem that affects both developed and developing countries, including Malaysia. To prevent anaemia, knowledge is a key parameter for changing attitudes and practices. Aim: This present study aims to determine the association of knowledge and practices in preventing nutritional anaemia with anaemia status of urban poor adolescents in Kuala Lumpur, Malaysia. Methods: A total of 209 urban poor adolescents (50.7% males and 49.3% females) aged 10 to 17 years old were recruited from eight low-cost flats (People Housing Programme) in Kuala Lumpur, Malaysia. A self-administered questionnaire was used to assess the sociodemographic characteristics, knowledge and practices in preventing nutritional anaemia. Anaemia status from the haemoglobin level concentration was determined using HemoCue® 201 + hemoglobinometer. Results: The prevalence of anaemia among urban poor adolescents was 58.4%, particularly prevalent among females (p < 0.001) and household size of six and above (p = 0.036). Only 29.2% and 10.0% of them were found to have good levels of knowledge and practices in preventing nutritional anaemia, respectively. Adolescents with high knowledge level tended to be anaemic as compared to poor knowledge level (AOR(95% CI) = 2.20 (1.02, 5.61), p < 0.05) after adjusting for sex, household size and monthly household income. Conclusion: Findings showed high prevalence of anaemia and low levels of knowledge and practices of nutritional anaemia prevention among the urban poor adolescents. Nutrition education and intervention are needed to improve the anaemia status of the urban poor adolescents.

Evaluation of two weight stigma scales in Malaysian university students: weight self-stigma questionnaire and perceived weight stigma scale.

BACKGROUND: This study aimed to examine the psychometric properties of the Weight Self-Stigma Questionnaire (WSSQ) and Perceived Weight Stigma Scale (PWS) among Malaysian university students. METHODS: University students who were studying in a Malaysia university with a mean age of 24.0 years (n = 380; females 71.6%) were recruited through convenience sampling between 19 August and 30 September 2021. They completed a Google Form consisting of information on sociodemographic background, weight stigma, psychological distress and self-reported body weight and height. Psychometric testing was conducted using the classical test theory (including confirmatory factor analysis) and Rasch models to confirm the two-factor structure of WSSQ and the unidimensional structure of the PWS using the various fit indices. Concurrent validity of the total scores of WSSQ and PWS with psychological distress and body mass index (BMI) was also investigated. Internal consistency using Cronbach's alpha was conducted. RESULTS: The confirmatory factor analyses and Rasch analyses verified the two-factor structure for the WSSQ and the single-factor structure for the PWS. Both the WSSQ and PWS showed good internal consistency and good concurrent validity as demonstrated by their significant correlations with psychological distress and BMI. CONCLUSION: The WSSQ and PWS have strong validity and reliability, and they can both be used to assess weight stigma among Malaysian university students. LEVEL OF EVIDENCE: V: Descriptive study.

Fluid intake, hydration status and its association with cognitive function among adolescents in Petaling Perdana, Selangor, Malaysia.

BACKGROUND/OBJECTIVES: A cross-sectional study was undertaken to evaluate fluid intake and hydration status in association with cognitive function among 230 adolescents (10-14 years of age) in Petaling Perdana, Selangor, Malaysia. SUBJECTS/METHODS: Urine color was used to measure hydration status, while fluid intake was assessed using the 15-item beverage intake questionnaire. Cognitive function was assessed using the Wechsler Intelligence Scale for Children, Fourth Edition. RESULTS: More than half of the adolescents were mildly or moderately dehydrated (59.6%) and only one-third (33.0%) were well hydrated. Among the daily fluid types, intakes of soft drinks (r = -0.180; P = 0.006), sweetened tea (r = -0.184; P = 0.005) and total sugar-sweetened beverages (SSBs) (r = -0.199; P = 0.002) were negatively correlated with cognitive function. In terms of hydration status, cognitive function score was significantly higher (F-ratio = 4.102; P = 0.018) among hydrated adolescents (100.38 ± 12.01) than in dehydrated (92.00 ± 13.63) counterparts. Hierarchical multiple linear regression analysis, after adjusting for socio-demographic factors, showed that soft drinks (ß = -0.009; P < 0.05) and sweetened tea (ß = -0.019; P < 0.05) negatively predicted cognitive function (ΔR2 = 0.044). When further control for sources of fluid, hydration status (ß = -2.839; P < 0.05) was shown to negatively predict cognitive function (ΔR2 = 0.021). The above variables contributed 20.1% of the variance in cognitive function. CONCLUSIONS: The results highlight the links between fluid intake (soft drinks, sweetened tea, total SSBs) and hydration status with cognitive function in adolescents. Interventions aimed at decreasing the consumption of SSBs and increasing hydration status through healthy fluid choices, such as water, could improve cognitive performance in adolescents.

Psychological Factors and Cardiovascular Disease Risk Factors as Mediators of the Relationship between Overweight/Obesity and Cognitive Function among School Children in Kuala Lumpur, Malaysia.

BACKGROUND: Recent research suggests that a negative relationship exists between adiposity and cognitive function in children. However, limited information is known on how they are related. This study aimed to examine the mediators of the relationship between overweight/obesity and cognitive function among school children in Kuala Lumpur, Malaysia. METHODS: This is a cross-sectional comparison study whereby 225 overweight/obese children matched for age, sex, and ethnicity with 225 normal weight children participated in this study. Body image dissatisfaction, disordered eating, and depressive symptoms were assessed through a self-administered questionnaire. Blood pressure was measured, whereas blood was drawn to determine insulin, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid profiles. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated using glucose and insulin levels. Wechsler's Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess cognitive function in children. Ordinary least square regression analysis was conducted to determine the direct and indirect relationships between weight status and cognitive function. RESULTS: A negative relationship was found between overweight/obesity with cognitive function. Overweight/obese children were on average 4.075 units lower in cognitive function scores compared to normal weight children. Such difference was found through mediators, such as body image dissatisfaction, disordered eating, depression, systolic blood pressure, triglycerides, HOMA-IR, and hs-CRP, contributing 22.2% of the variances in cognitive function in children. CONCLUSION: Results highlight the important mediators of the relationship between overweight/obesity and cognitive function. Consequently, future interventions should target to improve psychological well-being and reduce cardiovascular disease risk for the prevention of poorer cognitive performance in overweight/obese children.