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Background : The Movement Control Order (MCO), also known as the partial lockdown, was introduced in Malaysia in March 2020 to combat the COVID-19 pandemic, changing many public sector protocols and regulations. This may have implications for neonatal and maternity care and services, especially among new mothers. Objective : The aim of this study was to compare the postnatal experiences and feeding practices between mothers who gave birth before MCO (B-MCO) and during MCO (D-MCO). Method: One thousand fifty-one mothers with an infant under 18 months in Malaysia completed an online survey between July 2020 and October 2020. The survey advertisement was disseminated online via various social media platforms. Results: More D-MCO mothers faced a significant effect on the ability to pay rent/mortgage, with their spouses facing a higher impact on employment. D-MCO mothers were more likely to have changed their birth plans, perceived insufficient breastfeeding support, and experienced changes in postnatal services since MCO. In contrast, more B-MCO mothers had stopped breastfeeding during the MCO and started complementary feeding earlier than planned. Many mothers reported feeling down and lonely and having trouble sleeping and a poor appetite. D-MCO mothers had more time to focus on their health, whereas B-MCO mothers spent more time outdoors. Discussion: MCO affected mothers’ livelihood and postnatal experiences, potentially causing emotional distress. Hence, improved breastfeeding support, particularly at birth, is recommended, as is routine mental health screening during the postnatal checkup. Furthermore, because online contact was readily accessible during the pandemic, the efficacy of online breastfeeding support should be evaluated.

Introduction: Literatures suggest that insufficient physical activity as one of the contributors to non-communicable chronic diseases; nevertheless, data on the physical activity level is sparsely reported among individuals practising a vegetarian diet in Malaysia. The current study aims to determine the prevalence of insufficient physical activity and its association with socio-demographic factors, lifestyle factors and body weight status among 273 individuals practising a vegetarian diet in Klang Valley, Malaysia. Methods: A set of self-administered questionnaire was distributed to all vegetarians and their data on physical activity was determined using the Global Physical Activity Questionnaire (GPAQ). Results: The average years of practising vegetarianism was 14.2±9.6 years, and most of the vegetarians were practised ovo-vegetarian diet (44.0%). A majority of them were Chinese (54.9%) and female (64.8%), with an average age of 47.5 ± 13.1 years. The prevalence of overweight and obesity were 27.5% and 8.1%, respectively. According to GPAQ, about two in five vegetarians (46.2%) were having insufficient physical activity. Being females, older age, Chinese, married individuals, and those with high total household income level were found to be significantly associated with low physical activity level among Malaysian vegetarians (p <0.05). Conclusion: Since insufficient physical activity is one of the factors contributing to non-communicable chronic diseases, it is crucial to educate the importance of physical activity on overall health status, specifically for those who at risk of physically inactive. In addition, future studies can focus the causal associations based on the currently identified factors and physical activity levels, which can help to develop an effective intervention program among Malaysia vegetarians.

Background: Undernutrition and poor home environment in the first 2 years of life may have long-term effects on cognitive development. Aims: To determine the influence of linear growth and home environment towards cognitive development in the first year of life of Malaysian infants. Study design: Cross-sectional findings at 12–13 months from a prospective cohort study of infants in Malaysia. Subjects: One hundred fifty-one infants recruited at 2–5 months were visited at home at 12–13 months (M = 12.95, SD = 0.98). Outcome measures: Maternal and infant measures during pregnancy and at birth were obtained from patient health clinic cards. Weight and length of infants were measured at 12–13 months. Home environment and cognitive development were assessed using HOME inventory and Bayley-III, respectively. Results: About 22.5% of infants experienced stunting and 14.6% had low home environment quality. The mean cognitive score was 94.54 (SD = 12.00). Stunted infants had 7.59 lower cognitive scores than non-stunted infants, while infants with low home environment quality had 12.09 lower cognitive scores than those with high home environment quality. Cognitive scores increased with better home environment quality in both stunted and non-stunted infants, but stunted infants scored lower than non-stunted infants in all conditions. Conclusion: Stunting, a form of chronic undernutrition, and poor home environment may significantly influence cognitive development of infants. Interventions to prevent undernutrition should start as early as during pregnancy and caregivers should be informed on their roles in providing cognitive stimulation within the home environment for their children.

Objective To compare the performance of different anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and a body shape index to predict high blood pressure (BP) in adolescents using the 90th and 95th percentiles as two different thresholds. Design Cross-sectional study. Setting Probability proportionate to size was used to randomly select two schools in Selangor state, Malaysia. Participants A total of 513 adolescents (58.9% women and 41.1% men) aged 12–16 years were recruited. Primary and secondary outcome measures Weight, height, WC and BP of the adolescents were measured. The predictive power of anthropometric indices was analysed by sex using the receiver operating characteristic curve. Results BMI and WHtR were the indices with higher areas under the curve (AUCs), yet the optimal cut-offs to predict high BP using the 95th percentile were higher than the threshold for overweight/obesity. Most indices showed poor sensitivity under the suggested cut-offs. In contrast, the optimal BMI and WHtR cut-offs to predict high BP using the 90th percentile were lower (men: BMI-for-age=0.79, WHtR=0.46; women: BMI-for-age=0.92, WHtR=0.45). BMI showed the highest AUC in both sexes but had poor sensitivity among women. WHtR presented good sensitivity and specificity in both sexes. Conclusions These findings suggested that WHtR might be a useful indicator for screening high blood pressure risk in the routine primary-level health services for adolescents. Future studies are warranted to involve a larger sample size to confirm these findings.

Introduction: Understanding childhood obesity becomes vital as a tremendous increase in the prevalence of overweight/obesity among children and adolescents was observed. This cross-sectional study aimed to investigate the associations between sociodemographic and psychological characteristics with body-mass-index-for-age (BAZ) among adolescents in Sibu, Sarawak. Methods: A total of 375 students (32.0% males and 68.0% females; 15-17 years old) at four randomly selected public secondary schools were recruited. A questionnaire on sociodemographic and psychological characteristics (self-efficacy for physical activity, weight management, and nutrition, body discrepancy score, and sociocultural pressure to be thin) were used to gather information. Body weight and height were also assessed. Results: Around 18.6% respondents were found to be overweight/obese while nearly 5.0% were categorized as thin. In multiple linear regression, three significant predictors, namely body discrepancy score, being Iban (Reference: Chinese) and sociocultural pressure to be thin explained 45.1% of the variance in BMI-for-age z-score. Conclusion: Future interventions on adolescent body weight management should consider incorporating sociodemographic and psychological factors such as the development of positive body image, uniqueness in cultural value, and management of perceived sociocultural pressures to increase their effectiveness.

Introduction: Cognitive decline and cognitive impairment among older adults is a rising public health concern because of its association with increased risk of dementia, disability and mortality. In Malaysia, early identification of cognitive impairment is uncommon due to lack of understanding of risk profile of the elderly population. The objective of this study was to determine factors associated with cognitive impairment among community-dwelling older adults. Methods: This cross-sectional study was conducted among 698 community-dwelling older adults aged 60 years old and above in Klang Valley, Malaysia by using multi-stage sampling to determine the risk factors and predictors of cognitive impairment from a multidimensional approach. Multivariate logistic regression analysis was performed to determine the relationship between socio-demographic characteristics, physical activity, physical functional status and cognitive impairment. Results: Increased of age (OR = 1.056), being female (OR = 2.219) and Indian (OR = 2.722) were the risk factors for cognitive impairment, while years of education (OR = 0.765), physically active (OR = 0.823) and better physical function (OR = 0.843) were significantly associated with decreased risk of cognitive impairment. Marital and nutritional status failed to predict the risk of cognitive impairment. Conclusion: Given the protective effects of physical activity and physical function on the cognitive decline at later age, relevant policymakers should formulate appropriate health education programmes to promote regular physical activity to improve physical and cognitive function among Malaysians across all ages.

Access to food has been determined to be a factor that strongly influences the dietary intake and eating habit of indigenous people (Orang Asli, OA). This study explored food acquisition and the barriers in obtaining traditional and market foods among the Jahai subtribe (within the Negrito ethnic group) via a qualitative approach. Twenty-eight OA (14 males and 14 females) from Gerik, Perak, Malaysia participated in four focus group discussions (FGDs; two male-only and two female-only groups; seven informants in each FGD). Thematic analysis was adopted to analyse the gathered data. The results found that the Jahai applied both modern (buying and receiving food assistance) and traditional (gathering, farming, fishing, and hunting) methods in obtaining food. The barriers they faced in gathering sufficient food supply included low purchasing power, high demand for food, high transport costs, depletion of food supplies in their surroundings, threats from wild animals on the farm and during food searching activities, and food sharing. Food preparation methods practiced by the OA include roasting and grilling, frying, simmering (gulai), and boiling. In conclusion, this study enhances our understanding of the dietary behaviour of the Jahai subtribe and highlights restricted food access among the OA, which demands urgent attention.

In spite of the high prevalence of overweight and obesity among the Orang Asli (OA) of Malaysia being an increasing concern due to the associated adverse health implications, information regarding this issue is scarce. This cross-sectional study is aimed to investigate the predictors of overweight and obesity and its association with blood pressure and quality of life among Senoi OA women. A total of 19 villages at Batang Padang, Perak, were selected out of a total of 56 villages using a simple random sampling, in which 355 Senoi OA women were participated in the study. Face-to-face interviews were conducted to obtain information on sociodemographic characteristics, dietary intake, physical activity, and quality of life. Weight, height and blood pressure were also measured. The prevalence of overweight and obesity were 32.4% and 26.2%, respectively. In terms of multiple linear regression, monthly household income, total energy intake, and metabolic equivalents (METs) for domestic activities were found to have significantly contributed to body mass index (BMI). Furthermore, BMI contributed significantly towards levels of blood pressure and quality of life after controlling for monthly household income, total energy intake, and METs for domestic activities. In conclusion, there should be urgent attention to poverty and overweight/obesity among the OA women. The findings would aid in alerting policy makers and health professionals as underweight is no longer a sole nutritional problem among OA but it appears to be coexisting with overweight and obesity. Strategies for improving their socioeconomic status, promoting a balanced and moderate diet, and encouraging involvement of OA women in physical activities should be implemented to prevent overweight and obesity.

Background/objectives: A large number of studies on anemia have focused mostly on pregnant women or children. The vegetarian population, which is another potential risk group for anemia, remains largely unexplored. Therefore, this cross-sectional study examined the associations of the sociodemographic, lifestyle, nutritional, and psychological factors with the anemia status among female adult vegetarians. Subjects/methods: A total of 177 female vegetarians were recruited from a Buddhist and Hindu organization in Selangor, Malaysia. The participants completed a self-administered questionnaire, which analyzed their sociodemographic characteristics, physical activity level, sleep quality, depression, anxiety, and stress. The body weight, height, waist circumference, and body fat percentage of the participants were also measured. A 3-day dietary recall was conducted to assess their dietary intake. Blood samples (3 ml) were withdrawn by a nurse from each participant to determine the hemoglobin (Hb) level. Results: The findings revealed 28.2% of the participants to be anemic. The age group (AOR = 2.46, 95% CI = 1.19-5.05), marital status (AOR = 2.69, 95% CI = 1.27-5.71), and percentage of energy from protein (AOR = 5.52, 95% CI = 1.41-21.65) were the significant predictors of anemia. Conclusions: Anemia is a public health problem among female vegetarians in this study. Health promotion programs that target female adult vegetarians should be conducted to manage and prevent anemia, particularly among those who are married, aged 50 and below, and with an inadequate protein intake.

Introduction: Night eating syndrome (NES) has been progressively drawing attention and becoming a global concern due to its clinical implications. However, the study related to NES was found to be scarce in Malaysia. As such, this study aimed to determine the risk factors of NES among Malaysian public university students. Methods: This cross-sectional study involved 270 participants (mean age: 20.9±1.4 years), who were selected randomly from three different course disciplines at a public university in Selangor, Malaysia. The data were collected using a self-administered questionnaire on socio-demographic background, NES, depression, anxiety, stress, sleep quality, and disordered eating. Weight, height, and waist circumference of the participants were measured. Results: Results showed that 12.2% of the participants were engaged in NES. Binary logistic regression identified four significant risk factors of NES namely, being a male (AOR = 3.050, 95% CI = 1.129 – 8.238), persuading in a technical-stream course (AOR = 6.010, 95% CI = 2.057 – 17.555), being a stressful student (AOR = 3.580, 95% CI = 1.149 – 11.151), and having poor sleep quality (AOR = 4.664, 95% CI = 1.431 – 15.209). Conclusion: Early screening process should be conducted from time to time in which university students with potentially NES are able to receive necessary behavioural and cognitive therapy in order to recover.

The prevalence and factors associated with metabolic syndrome (MetS) remain unknown in Malaysian vegetarians. This cross-sectional study aimed to determine the prevalence of MetS among vegetarians in Kuala Lumpur and Selangor and its associated factors. The data on socio-demographic characteristics, vegetarianism practises, lifestyle behaviours, body weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and blood lipid profiles were collected from 273 vegetarians. A majority of the respondents were lacto-ovo vegetarians (44.0%), females (64.8%) and Chinese (54.9%). The prevalence of MetS was 24.2%. High BP (48.7%) and high WC (43.6%) were the most common MetS components. Females had lower WC, SBP, DBP, FBG, TG and higher HDL-c (p < 0.05) as compared to males. Multiple logistic regression analysis showed that being overweight and obese (Odds Ratio (OR) = 7.74, 95% Confidence Interval (CI): 4.04⁻14.82) was the main risk factor of MetS after being adjusted for sex and age. This study found that one in four vegetarians had MetS. An intervention programme should be developed to reduce Body Mass Index (BMI) among vegetarians, especially among those who are found to be overweight and obese.

Introduction: Childhood stunting is recognised as one of the most significant barriers to human development. This cross-sectional study aimed to determine the factors associated with stunting among Orang Asli (OA) preschool children in Negeri Sembilan, Malaysia. Methods: A total of 264 children (50.9% boys and 49.1% girls) aged 2-6 years (M=4.04, SD=1.21 years) including their mothers from 14 OA villages in Negeri Sembilan participated in this study. Mothers were interviewed to obtain information regarding socioeconomic status, sanitation facility and personal hygiene. The height of the children and their mothers were measured. Venous blood samples were drawn from the children to estimate haemoglobin level, and stool samples were collected to screen for intestinal parasitic infections. Results: Approximately one third of the children (35.6%) and 7.8% of the mothers were stunted. One in five of the children were anaemic (21.6%), while one- third had intestinal parasitic infections (35.0%). Low birth weight (AOR=2.526, 95% CI: 1.3104.872; p=0.006), anaemia (AOR=2.742, 95% CI: 1.265-5.945; p=0.011), presence of intestinal parasitic infections (AOR=2.235, 95% CI: 1.310-3.813, p=0.003), not wearing shoes (AOR=2.602, 95% CI: 1.453-4.660; p=0.001), absence of piped water at home (AOR=2.395, 95% CI: 1.047-5.476; p=0.039), dirty nails (AOR=1.956, 95% CI: 1.163-3.289, p=0.011), and stunted mothers (AOR=3.443, 95% CI: 1.334-8.890; p=0.011) were identified as significant factors for childhood stunting. Conclusion: It is suggested that the factors identified associated with childhood stunting be included in future intervention programmes that address stunting among OA children.

Although there are numerous studies on binge eating behavior in the Western countries, studies on this behavior in Malaysia are still limited. Therefore, this cross-sectional study aimed to determine the risk factors associated with binge eating behavior among adolescents in Malaysia. The study included 356 adolescents (42.7% males and 57.3% females), aged 13 to 16 years. They completed a self-administered questionnaire on demographic and socioeconomic backgrounds, frequency of family meals, family meal environments, family cohesion, perception of body size, self-esteem, depressive symptoms, perfectionistic self-presentation, and binge eating behavior. Furthermore, their weight, height, and waist circumference were measured. It was found that 14.0% of the participants engaged in binge eating behavior (15.2% in females and 12.5% in males). Additionally, it was identified that high levels of depressive symptoms, high levels of body dissatisfaction, poor family cohesion, and low self-esteem were significantly contributed to binge eating behavior after controlling for sex (adjusted R² = 0.165, F = 15.056, p < 0.001). The findings may suggest that improving the relationships between family members, along with eliminating adolescents' negative emotions could help in the prevention of binge eating behavior among adolescents. The identified modifiable risk factors should be incorporated into binge eating preventive programs to increase the effectiveness of the programs.

The understanding on the roles of obesity and lifestyle behaviors in predicting executive function of adolescents has been limited. Low executive function proficiency may have adverse effects on adolescents' school academic performance. This cross-sectional study aimed to examine the relationship between BMI-for-age and multiple lifestyle behaviors (operationalized as meal consumption, physical activity, and sleep quality) with executive function (operationalized as inhibition, working memory, and cognitive flexibility) on a sample of Malaysian adolescents aged between 12 and 16 years (N = 513). Participants were recruited from two randomly selected schools in the state of Selangor in Malaysia. Using a self-administered questionnaire, parent participants provided information concerning their sociodemographic data, whereas adolescent participants provided information regarding their meal consumptions, physical activity, and sleep quality. The modified Harvard step test was used to assess adolescents' aerobic fitness, while Stroop color-word, digit span, and trail-making tests were used to assess adolescents' inhibition, working memory, and cognitive flexibility, respectively. Three separate hierarchical regression analyses were conducted for each outcome namely, inhibition, working memory, and cognitive flexibility. After adjusted for sociodemographic factors and BMI-for-age, differential predictors of inhibition and working memory were found. Habitual sleep efficiency significantly and positively predicted inhibition. Regular dinner intakes, physical activity levels, and sleep quality significantly and positively predicted working memory. Household income emerged as a consistent predictor for all executive function domains. In conclusion, an increased trend of obesity and unhealthy lifestyles among adolescents were found to be associated with poorer executive function. Regular dinner intakes, higher physical activity levels and better sleep quality predicted better

Objective: To examine the types of coping strategies practised by Indigenous women or Orang Asli (OA) in Peninsular Malaysia during times of food shortage and to determine the level of severity for food insecurity that will trigger each specific coping strategy. Design: A qualitative case study was conducted. Pertinent information about each type of coping strategy was gathered by in-depth interviews. To gauge the level of severity for each of the coping strategies, focus group discussions (FGD) were held. Thematic analysis was used for data analysis. Setting: OA villages in the states of Kelantan, Pahang, Perak and Selangor, Malaysia. Subjects: Sixty-one OA women from three ethnic groups (Senoi, Proto-Malay and Negrito) for in-depth interviews and nineteen OA women from the Proto-Malay ethnic group for three FGD. Results: The findings identified twenty-nine different coping strategies and these were divided into two main themes: food consumption (sub-themes of food consumption included dietary changes, diversification of food sources, decreasing the number of people and rationing) and financial management (sub-themes of financial management included increasing household income, reducing expenses for schooling children and reducing expenses on daily necessities). Three levels of severity were derived: less severe, severe and very severe. Conclusions: This information would enable local authorities or non-governmental organisations to more precisely target and plan interventions to better aid the OA communities needing assistance in the areas of food sources and financial management.

Introduction: A vegetarian diet is generally considered as healthy for preventing metabolic-related diseases. There is lack of studies in Malaysia comparing the nutritional status of vegetarians and non-vegetarians. This cross-sectional study aims to compare body weight status, dietary intake and blood pressure level between these two groups. Methods: A total of 131 vegetarians and 135 non-vegetarians were recruited using convenience sampling from a Buddhist organisation in Kuala Lumpur. Body weight, height, waist circumference, percentage of body fat, and blood pressure measurements were taken, while dietary intake was assessed using a 2-day 24-hour dietary recall. Results: More vegetarians were underweight than non-vegetarians (31.3% vs 15.6%), while prevalence of overweight and obesity was higher among the non-vegetarians (23.7% vs 9.9%). A higher proportion of non-vegetarians (34.1%) had an unhealthy range of body fat percentage and significantly higher risk of abdominal obesity (24.4%) than the vegetarians (19.1% body fat; 13.7% abdominal obesity). Mean intakes for protein and fat were significantly lower among the vegetarians, while no significant differences were observed in the mean intake for energy and carbohydrate. Vegetarians had significantly higher intakes of vitamins C, D and E, calcium, potassium and folate, while vitamin B12 intake was significantly higher in the non-vegetarians. More non-vegetarians presented with unhealthy blood pressure status. Conclusion: Vegetarians in this study generally showed healthier dietary intake and lower body fatness than the non-vegetarians. Studies are suggested to be undertaken on a bigger sample size of vegetarians to confirm these findings.

Aim: The aim of this study is to describe epidemiology, clinical features, laboratory data and severity of respiratory syncytial virus (RSV) acute lower respiratory infection (ALRI) in Malaysian children and to determine risk factors associated with prolonged hospital stay, paediatric intensive care unit (PICU) admission and mortality. Methods: Retrospective data on demographics, clinical presentation, outcomes and laboratory findings of 450 children admitted into Tuanku Jaafar Hospital in Seremban, Malaysia from 2008 to 2013 with documented diagnosis of RSV ALRI were collected and analysed. Results: Most admissions were children below 2 years old (85.8%; 386/450). Commonest symptoms were fever (84.2%; 379/450), cough (97.8%; 440/450) and rhinorrhea (83.6%; 376/450). The median age among febrile patients (n = 379) was 9.0 months with interquartile range (IQR) of 4.0‐19.0 months whereas the median age among those who were apyrexial (n = 71) was 2 months with IQR of 1‐6 months (P‐value <0.001). 15.3% (69/450) needed intensive care and 1.6% (7/450) died. Young age, history of prematurity, chronic comorbidity and thrombocytosis were significantly associated with prolonged hospital stay, PICU admission and mortality. Conclusions: Infants less than 6 months old with RSV ALRI tend to be afebrile at presentation. Younger age, history of prematurity, chronic comorbidity and thrombocytosis are predictors of severe RSV ALRI among Malaysian children. Case fatality rate for Malaysian children below 5 years of age with RSV ALRI in our centre is higher than what is seen in developed countries, suggesting that there is room for improvement.

Introduction: University students are potentially important targets for the promotion of healthy lifestyles as this may reduce the risks of lifestyle-related disorders later in life. This cross-sectional study examined differences in eating behaviours, dietary intake, weight status, and body composition between male and female university students. Methodology: A total of 584 students (59.4% females and 40.6% males) aged 20.6±1.4 years from four Malaysian universities in the Klang Valley participated in this study. Participants completed the Eating Behaviours Questionnaire and two-day 24-hour dietary recall. Body weight, height, waist circumference and percentage of body fat were measured. Results: About 14.3% of males and 22.4% of females were underweight, while 14.0% of males and 12.3% of females were overweight and obese. A majority of the participants (73.8% males and 74.6% females) skipped at least one meal daily in the past seven days. Breakfast was the most frequently skipped meal. Both males and females frequently snacked during morning tea time. Fruits and biscuits were the most frequently consumed snack items. More than half of the participants did not meet the Malaysian Recommended Nutrient Intake (RNI) for energy, vitamin C, thiamine, riboflavin, niacin, iron (females only), and calcium. Significantly more males than females achieved the RNI levels for energy, protein and iron intakes. Conclusion: This study highlights the presence of unhealthy eating behaviours, inadequate nutrient intake, and a high prevalence of underweight among university students. Energy and nutrient intakes differed between the sexes. Therefore, promoting healthy eating among young adults is crucial to achieve a healthy nutritional status.