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Nutritional status of people with intellectual disability (PWID) is always at risk and developing a dietary assessment tool is important. This study aims to test reliability (inter-rater reliability and test-retest reliability) and comparable validity (limit of agreement against a multiple pass 24-hour diet recall recorded by a professional dietitian) of a recently developed dietary assessment kit, CIDDIE Kit©, that specialised for a more dependent group of PWID, focusing on preschool aged children. The CIDDIE Kit© was given to 26 parents or caretakers of children with intellectual disabilities (ID) registered with three selected Community Based Rehabilitation Centre in the Klang Valley area. Each subject was asked to complete two sets of CIDDIE Kit© in a two-week interval session. Meanwhile, a certified dietitian conducted a 24-Hour Diet Recall among the same 26 subjects. The validity and reliability of CIDDIE Kit© were analysed using Bland-Altman method, percentage of correctly classified quartile, Intra-class Correlation Coefficient (ICC) value and Pearson’s correlation coefficient. For comparable validity test, the estimated intake from CIDDIE Kit© and Multiple Pass 24-Hour Diet Recall were considerably in agreement to each other. The test-retest reliability analysis showed significant high similarity (p < 0.001) between the estimated intake from both phases of CIDDIE Kit© where the ICC value ranged approximately 0.9 (R = 0.889 - 0.930). The inter-rater reliability analysis was significantly positive (p < 0.001) and strong correlation (indicating internal consistency), r (0.706 – 0.853). The specially designed CIDDIE Kit© can provide a considerably valid and reliable assessment.

Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute’s guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.

Background: Sufficient intake of macronutrients and micronutrients are essential for child growth. Many children with autism spectrum disorder (ASD) however are reported to be picky eaters which may lead to malnourishment. As diet and behaviour are importantly interconnected, this study aims to determine the level of knowledge on nutrition among parents and special educators of children with ASD. Methods: A cross-sectional study was conducted at a National Autism Centre in Kuala Lumpur, Malaysia from May to August 2018. A 37-item questionnaire was self-administered to the respondents who attended a series of training of trainers’ sessions. The data was collected and analysed descriptively. A total of 209 respondents participated with 153 parents and 56 special educators of children with ASD. Results: Only 37.9% of the parents agreed that their children’s diet contains balanced nutrition. Majority of the parents and special educators had the perception that sugar, junk food and gluten are bad for the children, but they were still given due to the accessibility and convenience. Conclusion: The low level of knowledge among parents and special educators about the nutrition of children with ASD indicates that a measure should be taken to increase awareness and to overcome the malnutrition among ASD children. Keywords: gluten, casein, diet, supplement, malnutrition DOI : http://dx.doi.org/10.17576/JSKM-2021-1901-14

Background This study aimed to compare the nutritional and bone health status between young men with mild-to-moderate intellectual disability and those without intellectual disability and to determine predictors for their bone health status. Method A total of 95 men (47 men with intellectual disability; 48 men without intellectual disability), aged 20-39 years, participated in this study. Anthropometric profile, dietary intake, physical activity level and calcaneal speed of sound (SOS) were collected. Results The men with intellectual disability had moderate diet quality whilst the men without intellectual disability had poor diet quality. More participants with intellectual disability (97.9%) were inactive compared with their counterparts (10.4%). The SOS value was similar between groups and was lower than the reference. Increasing age and low physical activity level were negative predictors for bone health status. Conclusion Both young men with and without intellectual disability have suboptimal nutritional and bone health status. Strategies to improve their nutritional and bone health status are warranted.

Atypical mealtime behaviours in children with autism spectrum disorder (ASD) have been linked with oral sensory hypersensitivity that may contribute to food selectivity and weight issues. This cross-sectional study aims to determine the association between atypical mealtime behaviours and associated risk factors besides exploring the prevalence of overweight and obesity among Malaysian children with ASD in community settings. A total of 150 children with ASD aged 3–11 years participated in this study. A self-administered questionnaire on sociodemographic variables, mealtime behaviours and oral sensory processing was completed by the caregivers. The prevalence of overweight in the study samples was 18.5%, whereas obesity was 20.0%. In a multivariate analysis model, oral sensory processing (B = 0.608, 95% CI = 0.493, 0.722, p < 0.001), severity of autism symptoms (moderate and severe) (B = 2.585, 95% CI = 0.722, 4.448, p = 0.007) and younger children with ASD (B = −0.694, 95% CI = −1.189, −0.199, p = 0.006) were found as independent predictors of atypical mealtime behaviours. Children with ASD aged 3–11 years old have a higher prevalence of being overweight and obese, thus requiring regular anthropometric screening in community settings by relevant healthcare professionals. Furthermore, a relationship was found between oral sensory difficulties and atypical mealtime behaviours in children with ASD. A multidisciplinary approach is crucial in the overall management of food selectivity in this population.

IntroductionLike many other countries, the federal government of Malaysia took the initiative to implement nationwide home confinement as a preventive measure in response to the pandemic COVID-19 outbreak, better known as Movement Control Order (MCO). Many have suffered economically, which led to poor states of well-being. This study investigates the relationship between lifestyle, psychological factors affecting eating habits, and physical activity among government servants in states with the highest cumulative cases during the COVID-19 pandemic.MethodsA cross-sectional online survey was conducted among 210 government servants from four states (Selangor, Sabah, Kuala Lumpur, and Johor) from May 2021 to June 2021. Three validated questionnaires were used, namely, Emotional-Eater Questionnaire (EEQ), and Malay International Physical Activity Questionnaire (IPAQ-M) from López-Moreno et al. (1).ResultsThere were significant gender differences (P < 0.001) for supplement intake, with 30.4% among men and 62.3% in women. Almost half (49.1%) were classified as emotional or very emotional eaters. Also, a significant difference (P < 0.005) was found in the perception of boredom and apathy between men (35.7%) and women (31.8%). A majority (56.2%) stated that their mood positively affected their eating habits. The total metabolic equivalent of task (MET) for 132 subjects was 3495.8 ± 3862.7 min/week for physical activity. Significant differences were observed between MET and gender (Mann–Whitney U-test: P = 0.019), with men showing higher MET value (5001.4 ± 5354.0 min/week men, 2864.3 ± 2754.3 min/week women). A significant difference was observed among women for body weight and body mass index (BMI) before and during MCO (P < 0.001). For the emotional eater, there were correlations with eating habits before the MCO for quantity of food intake (P = 0.003), frequency of mealtime (P < 0.001), changes of food habits (P = 0.005), cooking methods (P = 0.016), and frequency of food intake (P = 0.020). There is no correlation (P = 0.577) between psychological factors affecting eating habits and physical activity during COVID-19.ConclusionChanges were reported before and during MCO on lifestyle, eating habits, and physical activity. Such information will help design strategies to improve the economic and health status among government servants in Malaysia during the implementation of MCO or something similar.

Dietetic profession has grown from mainly clinical setting to several other settings that was not thought possible until recently such as hosting healthy cooking shows to personalised online consultation. With the similar number of credit hours allocated for first degree dietetics students, conventional method of teaching would not be sufficient in preparing them for endless opportunity of working world. Hence, active learning is a timely approach in addressing this issue. The objective of this paper is to introduce a newly created program (DietitianJr@UKMTM) that applied active learning in equipping dietetics first degree students with skills that may be useful for the unconventional future jobs. DietitianJr@UKMTM is an annual program created in fulfilling Patient Education course outcome that involves community. Dietetics students were divided into four groups that introduced them to four main working areas of a Dietitian, i.e. inpatient, outpatient, food service and community service. Several stages were involved starting with lectures and case study discussions on basic concept and protocol of creating patient education material, followed by a need’s assessment survey, creating educational tools and a minimum of four discussion sessions with supervisors. This program was conducted among primary school children (aged 8-11 years) with the objective of introducing healthy eating concept and dietitian career. Results shows a highly positive feedback from the participants for each of the three-year school-holiday program. It is hoped that this fun-learning program will not only provide experience to dietetic students through authentic learning, but also educating the community on healthy eating and the importance role of dietitians.

Atypical dietary behaviour of children and adolescents with autism make it challenging for their parents to feed a balance diet to them. This qualitative study aims to explore food practices and source of information regarding food practices among caregivers of Malay children and adolescent with autism. A total of 19 caregivers (aged 35-53 years) of Malay children and adolescents with autism (aged 7-18 years) participated in focus group discussions. Respondents were selected using purposive sampling method from three selected special children's educational centers in Selangor and Negeri Sembilan areas. This focus group discussion was transcribed verbatim and analyzed with the assisted qualitative software (NVivo version 11), which several themes were formed. This study found that majority of respondents offered their children sunnah food, Omega-3 supplements and vitamin and mineral supplements, omitted food additives, gluten and casein, seafood, egg and legumes as they thought these may help in improving their children’s behavior and health. The main sources of information regarding these food practices were Autism Club Malaysia, internet, doctor and religious teacher. Majority of respondents had never consulted both dietitians or nutritionists. Nutritionists or dietitians should provide scientific evidence information on nutritional practices through autism association and internet to ensure that caregivers can manage their children’s nutritional problems more effectively. DOI : http://dx.doi.org./10.17576/JSKM-2019-1702-03

Refereed/Peer-reviewed Background: Food selectivity is an emerging health concern among children with autism spectrum disorder (ASD). Food selectivity is used to describe food refusal, limited food choices, and/or food fussiness. Method: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-Scoping Review Guidelines to systematically identify the relationship between food selectivity and oral sensory sensitivity and the possible consequences of food selectivity on nutrient intake in children with ASD.Thirty studies were included in the review based on search terms from three online databases. Results: Assessment of food selectivity, oral sensory sensitivity, and nutrient intake was found to be focused primarily on the parent-report technique. Only a handful of studies have used Cronbach’s alpha to measure the psychometric properties. Twenty-one of the included studies reported a higher rate of food selectivity in children with ASD than typically developing (TD) children. Notably, several studies (n =7) have identified oral hypersensitivity (e.g., taste/smell) as a significant risk factor for food aversion and/or limited variety in children with ASD. Compared with TD children, the ASD group significantly consumed significantly fewer fruits/vegetables (n = 8). The intake of micronutrients, including vitamin A, vitamin B6, folate, vitamin B12, vitamin C, vitamin D, calcium, iron, and zinc that associates with food selectivity, was also low (n=13). Conclusion: Implementation of screening and assessment protocols using valid and reliable instruments to identify food selectivity and oral sensory sensitivity is crucial for the medical evaluations of children with ASD.

BACKGROUND Good nutrition knowledge among carers of people with intellectual disability (ID) living in group homes is essential as they have a primary role in food provision for residents. Research on the nutrition knowledge of carers is limited. METHOD This cross-sectional study assessed the level of general nutrition knowledge in a convenience sample of Australian carers (C) of people with ID and compared this to the general Australian community (CM). Nutrition knowledge was evaluated using the validated General Nutrition Knowledge Questionnaire. Total knowledge score as well as performance on instrument sub-sections (dietary guidelines, nutrient sources, healthy food choices and diet disease relationships) were assessed (expressed as %). Knowledge scores were adjusted for known confounders (age, sex, education level, BMI, living arrangement and English spoken at home) using generalised linear modelling. RESULTS A total of 589 participants were recruited (C: n = 40; CM: n = 549). Age (C: 40.8 ± 12.1 year; CM: 37.8 ± 13.3 years; P = 0.145), sex distribution (C: 62.5%; CM: 67.2% female; P = 0.602) and English spoken at home (C: 82.5%; CM: 89.6%; P = 0.183) were similar between groups, but BMI (C: 28.5 ± 5.7 kgm-2 ; CM: 25.3 kgm-2 ; P = 0.002) was significantly lower and tertiary education (C: 52.5%; CM: 85.1%; P

Food allergy in children has been a common issue due to the challenges of prescribing personalized nutrition with a lack of nutriepigenomics data. This has indeed further influenced clinical practice for appropriate management. While allergen avoidance is still the main principle in food allergy management, we require more information to advance the science behind nutrition, genes, and the immune system. Many researchers have highlighted the importance of personalized nutrition but there is a lack of data on how the decision is made. Thus, this review highlights the relationship among these key players in identifying the solution to the clinical management of food allergy with current nutriepigenomics data. The discussion integrates various inputs, including clinical assessments, biomarkers, and epigenetic information pertaining to food allergy, to curate a holistic and personalized approach to food allergy management in particular.

Aim Optimal nutrition support is important in the care of critically ill children as they are at higher risk of malnutrition and have a higher incidence of complications and mortality. The aim of this study was to review the delivery of enteral feeding to critically ill paediatric patients in the Paediatric Intensive Care Unit in a tertiary hospital in Malaysia. Methods This cross-sectional study was conducted in 53 subjects (30 males and 23 females) who were recruited on the day of admission and remained in the study until they were discharged, deceased or for a maximum of 14 days of Paediatric Intensive Care Unit stay. The median age of subjects was 10.2 (interquartile range 5.1–50.5) months old. Results Enteral nutrition was initiated within 21.0 (interquartile range 5.3–33.8) hours after admission and was interrupted in 66% of patients during the study, with a median duration of 11.5 (interquartile range 6.1–28.3) hours for each patient. The overall duration of enteral feeding interruptions was 20% of the total feeding time. The main reasons for interruptions were medical procedures (55%) and non-gastrointestinal complications (27%). Twenty-two (43.2%) of the patients were malnourished when admitted to the Paediatric Intensive Care Unit. The feeding initiation time, referral to the dietitian, and the frequency and duration of feeding interruptions were all positively associated with cumulative energy and protein deficits. Conclusions Malnutrition among critically ill children in the Paediatric Intensive Care Unit was prevalent; energy and protein deficits were substantial. Strategies to improve the delivery of nutritional support to this group of patients should be planned and implemented by multidisciplinary clinical teams.

Quality of life (QoL) is impaired in childhood obesity, but the literature on this is all from Western countries. Aim. To test for impairment of QoL in obese children in Malaysia, using parent-reported and child-reported QoL.Health-related Quality of Life was measured using the Paediatric Quality of Life Inventory version 4.0. Comparison of QoL between a community sample of 90 obese children (as defined by US CDC and Cole-IOTF definitions), median age 9.5 y (interquartile range [IQR] 8.6, 10.5 y) and 90 control children of healthy weight (BMI less than the 85th centile of US reference data), median age 10.0 y (IQR 9.6, 10.5 y). Children were matched pair-wise for age, gender, and ethnic group, and controls were recruited from schools in the same area as obese participants.For child self-report, the healthy weight group had significantly higher QoL for the physical (median 82.9, IQR 65.7, 90.6), and psychosocial domains (median, 73.3, IQR 64.4, 83.3), and total QoL (median 76.1, IQR 64.1, 84.8) compared to the obese group (median 67.2, IQR 59.4, 81.3; median 62.5, IQR 53.3, 75.4; median 60.9, IQR 50.8, 73.9; all p0.001). There were no significant differences between the obese and healthy weight group for parent-reported physical health, psychosocial health, or total QoL.Obese children in Malaysia have markedly poorer QoL than their peers, but this is not evident when parent reports of QoL are used.

Few randomized controlled trials (RCTs) of interventions for the treatment of childhood obesity have taken place outside the Western world.To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur, Malaysia.Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds. The intervention was relatively low intensity (8 hours contact over 26 weeks, group based), aiming to change child sedentary behavior, physical activity, and diet using behavior change counselling. Outcomes were measured at baseline and six months after the start of the intervention. Primary outcome was BMI z-score, other outcomes were weight change, health-related quality of life (Peds QL), objectively measured physical activity and sedentary behavior (Actigraph accelerometry over 5 days).The intervention had no significant effect on BMI z score relative to control. Weight gain was reduced significantly in the intervention group compared to the control group (+1.5 kg vs. +3.5 kg, respectively, t-test p0.01). Changes in health-related quality of life and objectively measured physical activity and sedentary behavior favored the intervention group.Treatment was associated with reduced rate of weight gain, and improvements in physical activity and quality of life. More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes.

The present study examined objectively measured physical activity in Malaysian children and compared the differences in physical levels between obese and healthy weight children. Eighty-six obese children were matched for age and sex with 86 healthy weight children with median age 9.5 years. Habitual physical activity and sedentary behaviour were measured over 5 days using Actigraph accelerometers. Time spent sedentary was significantly higher in the obese group (90% vs. 86% of daytime; p = 0.001). Moderate-to-vigorous-intensity physical activity was significantly higher in the healthy weight group (1.2 vs. 0.7% of daytime, p < 0.001). In both healthy weight and obese children, physical activity levels were exceptionally low, although moderate-to-vigorous-intensity physical activity was significantly lower in the obese group than the healthy weight group. Efforts to prevent and treat obesity in Malaysian children will need a substantial focus on the promotion of reductions in sedentary behaviour and increases in physical activity.