Development, Validation, and Reproducibility of a Food Frequency Questionnaire (FFQ) for Adult Population in Brunei Darussalam

@#Introduction: The dietary intake of adults in Brunei Darussalam has not been thoroughly investigated via the food frequency questionnaire (FFQ). This study aimed to establish, validate and test the reproducibility of an FFQ to determine and evaluate the adult dietary intake in Brunei Darussalam. Methods: Participants were divided into; (1) development phase (50 adults); (2) validation phase (100 adults); (3) reproducibility phase (subsample of 40 adults). 3-day dietary record (3DR) was used in development phase to gather food items consumed. 2-day dietary record(2DR) was used as a reference method in validation. Nutrients analyze were energy, macronutrients, calcium, and vitamins A and C. Validation analysis were spearman correlation, mean difference, Bland-Altman plot, cohen’s kappa and cross-classification analyses. Reliability analyses were intra-class correlation coefficient (ICC), Cronbach’s alpha and cross classification to compare repeat FFQ administered with 1 to 3 months interval. Results: The FFQ consisted 138 food items from 12 food groups. In validation, mean difference between FFQ and 2DR exceeded 10%, spearman correlation were significantly strong (r=0.994 to r=0.107). Cross-classification demonstrated > 50% of nutrients were correctly and adjacently classified, Bland-Altman plots were relatively consistent for the two methods. Cohen’s kappa ranged from 0.081 to 0.040, demonstrating weak agreement. In reproducibility, ICC outcomes for FFQ1(0.463) and FFQ2(0.978), Cronbach’s alpha was > 0.8, and > 95% of the nutrients were correctly or adjacently classified. Conclusion: The FFQ designed in this study was valid due to the consistency with the dietary records; hence, a reliable tool to predict the dietary intake of Brunei Darussalam adults.

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 (β = −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.

Picky Eating Behaviour, Feeding Practices, Dietary Habits, Weight Status and Cognitive Function Among School Children in Kuala Lumpur, Malaysia

@#Introduction: Picky eating behaviour was linked to nutritional problems due to limited dietary variety. This study aimed to determine the causes and consequences associated with picky eating behaviour among school-aged children in Kuala Lumpur, Malaysia. Methods: A total of 339 children aged seven to nine years participated in this cross-sectional study. Socio-demographic factors, eating behaviours and child/ parental feeding style were assessed through parent’s questionnaires, while eating habits of children were accessed through child’s questionnaire. Body height and weight were measured; body mass index (BMI) was calculated. Cognitive function level was determined using the Raven’s Coloured Progressive Matrices test. Results: One third (38%) of the children were picky eaters and consumed lesser vegetables (χ2 =4.49,p=0.034) and fish (χ2 =5.55,p=0.019), but more milk and dairy products (χ2 =3.91,p=0.048), snacks (χ2 =6.25,p=0.012) and fast food (χ2 =7.35,p=0.007) compared to non-picky eaters. Picky eaters were more likely to have normal weight status based on weight-for-age, height-for-age and BMI-for-age compared to non-picky eaters (p<0.05). Picky eaters came from a household with other picky eaters in the family and their parents tend to use an instrumental feeding style. Picky eaters had a poorer cognitive function compared to non-picky eaters (p=0.03). Conclusion: We did not find significant differences in growth parameters between picky and non-picky eaters but picky eaters were more likely to have a poorer cognitive function. As parental feeding styles significantly influenced children’s eating behaviour, interventions should target parents to improve their children’s dietary variety.

Children's psychosocial factors of healthy meal preparation as predictors for nutritional status measures.

Involving school-age children in the preparation of healthy meals is shown to be associated with positive eating behavior. Yet, it remains unclear whether this can extend to their nutritional status. The present study aimed to determine the association of school-age children's psychosocial factors (knowledge, attitude, practice, self-efficacy) towards healthy meal preparation with their nutritional status (BMI-for-age, waist circumference, body fat percentage). Stratified random sampling was used to select primary schools (n = 8) in Kuala Lumpur, Malaysia. Two hundred school children aged between 9-11 years old were involved. Psychosocial factors towards healthy meal preparation were assessed using validated questionnaire. Anthropometry measures were determined using standard protocol. Almost half (46 %) of the school-age children were obese/overweight, 39 % were abdominally obese and 40 % were overfat. Approximately half had poor knowledge (49 %), poor practice (45 %), good attitude (56 %) and good self-efficacy (47 %) towards healthy meal preparation. Significant positive correlations were observed between knowledge with attitude (r = 0.23, p < 0.001); knowledge with self-efficacy (r = 0.30, p < 0.001); attitude with practice (r = 0.34, p < 0.001); attitude with self-efficacy (r = 0.59, p < 0.001) and practice with self-efficacy (r = 0.50, p < 0.001). Adjusted logistic regression revealed that school-age children with good attitude were less likely to be abdominally obese (OR = 0.87, 95 % Cl = 0.78 to 0.96) and overfat (OR = 0.84, 95 % Cl = 0.76 to 0.94). Children with good knowledge had lower risk of being abdominally obese (OR = 0.84, 95 % Cl = 0.72 to 0.97). Findings revealed that children's psychosocial factors were interrelated, and improvements may have the potential in affecting nutritional status. Hands-on healthy meal preparation should be explored further as an innovative approach to address the obesity epidemic.

Influences of psychosocial factors and home food availability on healthy meal preparation.

The involvement of children in healthy meal preparation activities has emerged as a potential strategy to promote healthy eating behaviour among children. However, there is a lack of understanding of children's internal (psychosocial factors) and external factors (home food availability) that may support the practice of preparing healthy meals. This study aimed to determine children's psychosocial factors of healthy meal preparation within themselves and their external environment of home food availability as predictors for the practice of healthy meal preparation. Public schools (n = 8) from all three zones (Bangsar-Pudu, Keramat and Sentul) in Kuala Lumpur, Malaysia, were selected through stratified random sampling. Two hundred children aged 9-11 and their parents participated. Children's psychosocial factors towards healthy meal preparation and their home food availability were assessed through children and parents, respectively, using validated questionnaires. Majority of the schoolchildren (86.5%) had poor practice of healthy meal preparation. Increased attitude (r = 0.344, P < 0.001) and self-efficacy (r = 0.501, P < 0.001) of healthy meal preparation and the availability of fruits (r = 0.304, P < 0.001), vegetables (r = 0.243, P < 0.001) and healthful ready-to-eat foods (r = 0.227, P = 0.001) at home were positively correlated with the practice of preparing healthy meals. After adjusting for age, sex and monthly household income, increased self-efficacy (P < 0.001), availability of fruits (P = 0.01) and lower availability of less healthful ready-to-eat food (P = 0.01) were associated with better healthy meal preparation practices. Outcomes revealed that positive self-efficacy of healthy meal preparation, home food availability of fruits and less healthful alternatives were associated with the practice of healthy meal preparation and thus should be targeted in future health-promotion strategy.

Nutritional Composition and Cost Differences between Gluten-Free and Gluten-Containing Food Products in Kuala Lumpur, Malaysia

@#Introduction: The demand for commercial gluten-free food products are increasing due to rising prevalence of lifestyle-related diseases. The market growth is forecasted to increase in numbers. However, to date nutritional comparison of gluten-free and gluten-containing food products is not done extensively in Malaysia. Therefore, this study aimed to investigate the nutritional composition and cost per 100 g between gluten-free and gluten-containing food products in selected grocery stores in Kuala Lumpur. Methods: A total of 106 food products comprising of gluten-free food products (n=41) and gluten-containing food products (n=65) were determined and compared for its nutritional composition and cost per 100 g. The products were obtained from 4 main grocery stores in Kuala Lumpur that supply gluten-free food products. The differences in nutritional composition and cost between both products were analysed by using independent samples t-test. Results: The results showed no difference in energy content between both products. Across the food products, 15 % of gluten-free food products showed higher carbohydrate content compared to its counterparts. Protein content in gluten-free products was 63 % lower than gluten-containing products. Among all gluten-free food products included in this study, only lasagne sheet has lower content of dietary fibre compared to its counterparts. The cost for majority of gluten-free food products was significantly higher, which was two- to four-fold higher compared to gluten-containing products. Conclusion: This study indicated that gluten-free food products showed no nutritional advantage especially in its macronutrients, hence, avoidance of gluten for healthy population may not be beneficial and rather costly.

Association between Dietary Patterns and Cardiometabolic Risks in Malaysian Punjabi Adults

@#Introduction: Globally, the prevalence of cardiovascular diseases (CVD) is high in Punjabi population. This could due to the increased cardiometabolic risks associated with diets high in dietary fats and refined grains. However, studies on the relationship between dietary pattern and cardiometabolic risks involving Malaysian Punjabis population are scarce. Hence, this study aims to determine the associations between dietary patterns and cardiometabolic risks in Malaysian Punjabi adults. Methods: Socio-demographic, lifestyle and dietary intake information was collected using self-administered questionnaire. Anthropometric measurements: weight and height for body mass index (BMI) calculation, waist circumference (WC); systolic (SBP) and diastolic blood pressure (DBP); and biomarkers: blood glucose, glycated haemoglobin A1c (HbA1c), triglycerides, total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), apolipoprotein A1 and B100 were obtained. Major dietary patterns were derived using principal component analysis. Association between dietary patterns and cardiometabolic risk factors were performed using ANCOVA and Kruskal-Wallis tests. Results: A total of 164 (35.4% males and 64.6% females) Punjabis were included in this study. Four dietary patterns were extracted, namely ‘fruits and vegetables diet’ (FVD), ‘whole grains, condiments and beverages diet’ (WCBD), ‘protein diet’ (PD) and ‘rice, noodles, cereals and meat diet’ (RNCMD). Significant associations were obtained for FVD with BMI (p=0.012), WC (p=0.011), SBP (p=0.020) and DBP (p=0.009); WCBD with TC (p=0.010), LDL-C (p=0.015) and apolipoprotein B100 (p=0.038). Conclusion: Dietary pattern comprised of fruits, vegetables and beverages containing antioxidant-rich spices, ginger, and black tea may lower cardiometabolic risks in Malaysian Punjabis, particularly in obesity, high blood pressure and hyperlipidaemia.

Factors associated with dental caries among selected urban school children in Kuala Lumpur, Malaysia

This study aimed to assess the nutritional status (BMI), oral health behaviour, sugar consumption and the associated factors with dental caries among a group of 7 to 11 years old children in Kuala Lumpur, Malaysia. Three hundred and twelve students were recruited from February to July 2013. Information gathered were their socio-demographic characteristics, body mass index, sugar consumption, oral-health behaviour, oral hygiene index and decay-missing-filled teeth (dmft) index. Anthropometry measurements and sugar intake was measured using verified tools. Meanwhile, dmft was examined using the World Health Organization (WHO) criteria. 53.7% of the children were of the normal body weight with mean sugar consumption of 31.81±4.24 g/day. Prevalence of dental caries was reported at 44.6% (95% CI: 42.2, 53.3) with a mean (SD) dmft of 1.27(1.84). No association was found between dental caries and weight status distribution. Most children tend to brush their teeth 2 times or more in a day (75%), however, they spent lesser time in tooth brushing (5.4%) and do not practice flossing (78%). Regression analysis showed that age (p<0.001), duration of teeth brushing (p=0.023) and the oral hygiene index (p=0.002) were significant predictors of dental caries among this group of children. Present findings suggest that younger children, longer time taken to brush teeth and poorer oral hygiene index were predisposing factors in dental caries, especially for young children. Hence, education on dental health is important to improve oral health behaviour and oral hygiene practices to further reduce dental caries incidences among young children.