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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.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.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.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.

ObjectiveTo 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.DesignA 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.SettingOA villages in the states of Kelantan, Pahang, Perak and Selangor, Malaysia.SubjectsSixty-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.ResultsThe 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.ConclusionsThis 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.

This study aimed to determine the relationship between breakfast consumption and body weight status among primary and secondary school children in Malaysia.This nationwide cross-sectional study involved 5,332 primary school children aged 6 to 12 years and 3,000 secondary school children aged 13 to 17 years. Height and weight were measured and BMI-for-age was determined. Socio-demographic backgrounds, breakfast habits and physical activity levels were assessed using questionnaires. Breakfast frequency was defined as follows: breakfast skippers (ate breakfast 0-2 days/week), irregular breakfast eaters (ate breakfast 3-4 days/week) and regular breakfast eaters (ate breakfast ≥5 days/week).The overall prevalence of breakfast skippers and irregular breakfast eaters was 11.7% and 12.7% respectively. Breakfast skipping was related to age, sex, ethnicity, income and physical activity level. Among primary school boys and secondary school girls, the proportion of overweight/obesity was higher among breakfast skippers (boys: 43.9%, girls: 30.5%) than regular breakfast eaters (boys: 31.2%, girls: 22.7%). Among primary school children, only boys who skipped breakfast had a higher mean BMI-for-age z-score than regular breakfast eaters. Among secondary school boys and girls, BMI-for-age z-score was higher among breakfast skippers than regular breakfast eaters. Compared to regular breakfast eaters, primary school boys who skipped breakfast were 1.71 times (95% CI=1.26-2.32, p=0.001) more likely to be overweight/obese, while the risk was lower in primary school girls (OR=1.36, 95% CI=1.02-1.81, p=0.039) and secondary school girls (OR=1.38, 95% CI=1.01-1.90, p=0.044).Regular breakfast consumption was associated with a healthier body weight status and is a dietary behaviour which should be encouraged.

To determine the associations between socio-demographic characteristics and pubertal status with disordered eating among primary school children.Using a stratified multi-stage sampling, a total of 816 children (282 boys and 534 girls) aged 10 to 11 years from 12 selected primary schools in the state of Selangor, participated in this study. Data were collected on socio-demographic characteristics, pubertal status and disordered eating behaviors. The Pubertal Development Scale and the Children's Eating Attitudes Test (ChEAT) were used to assess pubertal status and disordered eating, respectively. Logistic regression analysis was conducted to determine the risk factors of disordered eating.The prevalence of disordered eating was 30.8% (32.8% in boys and 29.7% in girls). However, the sex difference in the prevalence was not statistically significant. Age, ethnicity and pubertal status were significantly associated with disordered eating in univariate logistic regression analysis. Multivariate logistic regression analysis showed that among boys, being either in an advanced or post-pubertal stage (adjusted OR=8.64) and older age group (adjusted OR=2.03) were risk factors of disordered eating. However, among girls, being a Malay (adjusted OR=3.79) or Indian (adjusted OR=5.04) in an advanced or post-pubertal stage (adjusted OR=2.34) and older age group (adjusted OR=1.53) were risk factors of disordered eating.This study found one in three children had disordered eating. Since ethnicity and pubertal status were identified as risk factors, ethnicity-specific intervention programs on the prevention of disordered eating among children should take into consideration their pubertal status.

This study aimed to determine the association between disordered eating and overweight and also health-related quality of life (HRQOL) among adolescents in high schools of Tehran. The participants were 465 adolescents, aged 14–17 years. After anthropometric measurements, body mass index-for-age and body weight status were determined using World Health Organization cut offs. The Eating Attitudes Test-26 (EAT-26) and Pediatric Quality of Life Inventory (PedsQL™4.0) were used to assess disordered eating and HRQOL, respectively. Disordered eating was prevalent in 18.9 % of adolescents, with higher prevalence in girls (26.4 %) compared to boys (11.8 %; χ2:16.29, p < 0.05). Disordered eating was associated with overweight in girls (χ2 = 11.07, p < 0.05), but not in boys (χ2 = 2.01, p = 0.16). Disordered eating was associated with poor HRQOL especially in psychosocial domains of HRQOL. Considering the high prevalence of disordered eating and its association with overweight and poor HRQOL, preventive interventions targeting adolescents are recommended.

Over the course of 16 years, a high percentage of Orang Asli (OA) households in Malaysia has been found to be burdened with food insecurity. Therefore, a study was conducted to improve the understanding of the challenges faced by the OA in Peninsular Malaysia to achieve food security under traditional food systems. In this study, in-depth interview sessions, which were assisted by an interview protocol, were conducted with 61 OA women from nine villages that were selected purposefully across three states (Kelantan, Pahang, and Perak) in Peninsular Malaysia. Furthermore, thematic analysis was performed during data analysis. As a result, four themes were identified, namely (i) the failure in agriculture (sub-themes: threats from wild animals and insufficient land supply), (ii) ineffectiveness of traditional food-seeking activities (sub-themes: exhausting, tiring, dangerous, and time-consuming journey for food-seeking activities, depletion of natural commodities, reduced demands of natural commodities, and lack of equipment), (iii) weather (sub-themes: rainy and dry seasons), and (iv) water issues (subthemes: continuity of water supply and cleanliness of water). The identified modifiable factors of this issue should be incorporated into future schemes of food security intervention in order to efficiently manage the food shortage among the OA.

The mechanism linking biopsychosocial factors to disordered eating among university students is not well understood especially among Malaysians. This study aimed to examine the mediating role of psychological distress in the relationships between biopsychosocial factors and disordered eating among Malaysian university students. A self-administered questionnaire measured self-esteem, body image, social pressures to be thin, weight-related teasing, psychological distress, and disordered eating in 584 university students (59.4% females and 40.6% males). Body weight and height were measured. Structural equation modeling analysis revealed that the partial mediation model provided good fit to the data. Specifically, the relationships between self-esteem and weight-related teasing with disordered eating were mediated by psychological distress. In contrast, only direct relationships between body weight status, body image, and social pressures to be thin with disordered eating were found and were not mediated by psychological distress. Furthermore, multigroup analyses indicated that the model was equivalent for both genders but not for ethnic groups. There was a negative relationship between body weight status and psychological distress for Chinese students, whereas this was not the case among Malay students. Intervention and prevention programs on psychological distress may be beneficial in reducing disordered eating among Malaysian university students.

This study aimed to determine the relationship between child feeding practices, food habits, and anthropometric indicators with cognitive performance of preschoolers aged 4–6 years in Peninsular Malaysia ( n = 1933). Parents were interviewed on socio-demographic background, nutrition knowledge, child feeding practices and food habits. Height and weight of the preschoolers were measured; BMI-for-age, weight-for-age and height-for-age were determined. Cognitive performance was assessed using Raven’s Colored Progressive Matrices. The mean monthly household income was RM3610 and 59.6% of parents attained secondary education. Thirty-three percent of parents had good knowledge on nutrition, 39% satisfactory and 28% poor. For child feeding practices, perceived responsibility had the highest mean score ( M = 3.99, SD = 0.72), while perceived child weight had the lowest ( M = 2.94, SD = 0.38). The prevalence of possible risk of overweight, being overweight, and obesity were 3.9%, 7.9% and 8.1%, respectively, whereas the prevalence of underweight and stunting were 8.0% and 8.4%, respectively. Breakfast was the second most frequently skipped meal (16.8%) after dinner (18.1%). The mean cognitive score was 103.5 (SD = 14.4). Height-for-age and consumption of dinner were found to contribute significantly towards cognitive performance after controlling for socio-demographic background and parent’s nutrition knowledge.

This study examined eating behaviors among female adolescents. A total of 407 female students aged between 13-19 years were randomly selected from two secondary schools in Kuantan district, Pahang, Malaysia. All participants were required to complete a self-administered Eating Behaviors Questionnaire and their weight and height were measured by the researchers. A majority of the participants were Malays (65.3%), followed by Chinese (28.3%) and Indians (6.4%). There were 5.9% underweight participant, 75.4% were normal-weight and 18.7% were overweight. About one third (35.9%) never skipped any of the daily three meals, but another half (52.6%) skipped at least one meal a day and the remaining (11.5%) had even skipped all three meals in a day. The most frequently missed meals were breakfast (47.4%). Half (51.4%) snacked between meals daily and three in four (76.9%) had their meals with family members. No differences were found between the socio-demographic variables (age, household members, parent's total year of schooling, parental monthly income and living arrangement) and meal skipping behaviors. However, those who usually skipped meals were those who usually eat alone (Chi2= 16.933, p < 0.0001), overweight (Chi2= 15.943, p < 0.05) and were Malays (Chi2= 33.827, p < 0.05). In conclusion, meal skipping, snacking and practicing various weight loss behaviors were some of the unhealthy eating behavior depicted among adolescent girls. Focusing on promotion of healthy eating that stressed on the importance of regular intakes of main meals during adolescence is crucial for their current and future health and well-being.

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

This paper investigates the association between behavioural factors and BMI-for-age among early adolescents (10-11 years old) in Hulu Langat district, Selangor.This cross-sectional study was conducted among 333 primary school students. Body weight and height of the students were measured and their BMI-for-age was calculated. Eating behaviours, energy intake, energy expenditure, physical activity, and screen time were assessed using the Eating Behaviours Questionnaire and a 2-day dietary and physical activity recall, respectively. Data were analysed using multiple linear regression analysis.The prevalence of overweight and obesity (28.2%) was about twice the prevalence of thinness (11.1%). The mean energy intake and energy expenditure of the students was 1772±441kcal/day and 1705±331kcal/day, respectively. Three in five of the students (60.1%) skipped at least one meal and 98.2% snacked between meals daily. A majority of them (55.3%) were sedentary. Low energy intake (p0.05) and low energy expenditure (p0.05) were associated with high BMI-for-age. Energy expenditure (β=-0.033) and energy intake (β=-0.090) significantly explained 65.1% of the variances in BMI-for-age (F=119.170, p0.05).These findings suggested that promoting healthy eating and active lifestyle should be targeted in the prevention and management of obesity among early adolescents.

ObjectiveThe present study aimed to identify dietary patterns and determine the relationship between dietary patterns and cognitive ability among 12- to 13 year-old Malay adolescents in the urban areas of Gombak district in Selangor, Malaysia.DesignData on sociodemographic background were obtained from parents. Height and weight were measured and BMI-for-age was determined. Adolescents were interviewed on their habitual dietary intakes using a semi-quantitative FFQ. Cognitive ability was assessed using the Wechsler Nonverbal Scale of Ability in a one-to-one manner. Dietary patterns were constructed using principal component analysis based on thirty-eight food groups of the semi-quantitative FFQ.SettingUrban secondary public schools in the district of Gombak in Selangor, Malaysia.SubjectsMalay adolescents aged 12 to 13 years (n 416).ResultsThe mean general cognitive ability score was 101·8 (sd 12·4). Four major dietary patterns were identified and labelled as ‘refined-grain pattern’, ‘snack-food pattern’, ‘plant-based food pattern’ and ‘high-energy food pattern’. These dietary patterns explained 39·1 % of the variance in the habitual dietary intakes of the adolescents. The refined-grain pattern was negatively associated with processing speed, which is a construct of general cognitive ability. The high-energy food pattern was negatively associated with general cognitive ability, perceptual reasoning and processing speed. Monthly household income and parents’ educational attainment were positively associated with all of the cognitive measures. In multivariate analysis, only the high-energy food pattern was found to contribute significantly towards general cognitive ability after controlling for socio-economic status.ConclusionsConsumption of foods in the high-energy food pattern contributed towards general cognitive ability after controlling for socio-economic status. However, the contribution was small.

Body image plays an important role in the management of body weight, especially among female adolescents. This study examined the differences in body image perception, weight management knowledge, eating behaviour and physical activity between overweight and normal weight Malaysian female adolescents. Body mass index screening was done on 588 secondary school students to identify overweight (OW) and normal weight (NW) subjects. A BMI-for-age of =85th percentile and between =5th and85th percentile were used as cut-offs for identifying suitable subjects of overweight and normal weight, respectively. Fifty girls identified as being OW were matched for age and ethnicity with 50 NW students. Subjects completed a self-administered questionnaire on demographics, eating behaviour and physical activity, a weight management knowledge inventory (WMKI) and the Body Silhouette Chart. The study sample comprised Malays (40%), Chinese (30%) and Indians (30%) with a mean age of 14.76 ± 1.15 years. The majority of them were from families with a monthly household income of less than RM1,000. Significantly more NW subjects (χ2=6.112, p=0.013) than OW subjects had incorrect perception of their current body weight status. The WMKI revealed that more OW subjects (64%) than NW subjects (52%) had a low level of weight management knowledge. Eating behaviour patterns were not significantly different between OW and NW subjects, but more OW subjects skipped one or more daily meals as compared to their NW counterparts (χ2=0.174, p=0.010). Physical activity patterns were similar in both groups. Healthy eating and physical activity promotion programmes in schools should include sound weight management practices.

This study aimed to examine the role of psychological distress in the relationships between sociocultural influences (social pressure to be thin and weight teasing) and disordered eating. Data were collected from 584 university students (59.4% females and 40.6% males), aged 18-24 years old (M=20.6, SD=1.4), selected from four universities in the Klang Valley, Malaysia. Participants completed four standardized questionnaires which measured social pressure to be thin, weight-related teasing, psychological distress and disordered eating. A good fit structural equation modeling (SEM) model was developed for both sexes. For males, the SEM model revealed that sociocultural influences showed an indirect effect on disordered eating through psychological distress. For females, the model showed an indirect effect of sociocultural influences on disordered eating through psychological distress, as well as a direct effect of sociocultural influences on disordered eating. In conclusion, psychological distress mediated the relationships between sociocultural influences and disordered eating in both males and females. Our results suggest that disordered eating intervention programs on reducing psychological distress in university students may be beneficial.

Background The Pediatric Quality of Life Inventory™ Generic Core Scales (PedsQL™) 4.0 is a generalized assessment of health-related quality of life (HRQoL) based on adolescent self-report and parent proxy-report. This study aims to determine the construct validity and reliability of PedsQL™ 4.0 among a sample of Malaysian adolescents and parents. Methods A cross-sectional study was carried out at three selected public schools in the state of Selangor. A total of 379 Malaysian adolescents completed the PedsQL™ 4.0 adolescent self-report and 218 (55.9%) parents completed the PedsQL™ 4.0 parent proxy-report. Weight and height of adolescents were measured and BMI-for-age by sex was used to determine their body weight status. Results There were 50.8% male and 49.2% female adolescents who participated in this study (14.25 ± 1.23 years). The prevalence of overweight and obesity (25.8%) was four times higher than the prevalence of severe thinness and thinness (6.1%). Construct validity was analyzed using Confirmatory Factor Analysis (CFA). Based on CFA, adolescent self-report and parent proxy-report met the criteria of convergent validity (factor loading > 0.5, Average Variance Extracted (AVE) > 0.5, Construct Reliability > 0.7) and showed good fit to the data. The adolescent self-report and parent proxy-report exhibited discriminant validity as the AVE values were larger than the R2 values. Cronbach’s alpha coefficients of the adolescent self-report (α = 0.862) and parent proxy-report (α = 0.922) showed these instruments are reliable. Parents perceived the HRQoL of adolescents was poorer compared to the perception of the adolescent themselves (t = 5.92, p < 0.01). There was no significant difference in total HRQoL score between male and female adolescents (t = 0.858, p > 0.05). Parent proxy-report was negatively associated with the adolescents’ BMI-for-age (r = -0.152, p < 0.05) whereas no significant association was found between adolescent self-report and BMI-for-age (r = 0.001, p > 0.05). Conclusion Adolescent self-report and parent proxy-report of the PedsQL™ 4.0 are valid and reliable to assess HRQoL of Malaysian adolescents. Future studies are recommended to use both adolescent self-report and parent-proxy report of HRQoL as adolescents and parents can provide different perspectives on HRQoL of adolescents.