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We evaluate the pharmacokinetics, safety, and optimal dosages of intravitreal agents in silicone oil (SO)-filled eyes, addressing challenges in administering such therapies. We assessed the pharmacological properties and safety profiles of intravitreal drugs in SO-filled eyes, deriving conclusions and guidance from available literature and expert consensus. Preclinical data suggest comparable half-lives of anti-vascular endothelial growth factoragents in SO-filled eyes, but clinical evidence is mainly from case reports and small series. Available research prioritizes standard dosages, particularly for bevacizumab (1.25 mg), supported by stronger evidence than aflibercept (2 mg) or ranibizumab (0.5 mg). Intravitreal steroids, especially dexamethasone at 0.7 mg, show efficacy and safety, while evidence for fluocinolone acetonide at 0.19 mg is limited. Intravitreal methotrexate has been reported at the dosage of 250-400 μg, with keratitis as the primary expected side effect. Case reports indicate tolerability of standard dosages of antivirals (foscarnet 1.2-2.4 mg/0.1 mL, ganciclovir 4 mg/0.1 mL) and the antibiotic combination piperacillin/tazobactam (250 μg/0.1 mL). We offer guidance based on current, but limited, literature. Standard dosage of intravitreal agents should be carefully considered, along with close monitoring for potential side effects, which should be discussed with patients., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background/objectives: To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery., Subjects/methods: Eligible operations between 01/04/2016 and 31/03/2022 from centres supplying data to the UK national cataract audit with complete data including patients' gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA) were included. A logistic regression model was fitted to identify risk factors and calculate their odds ratios (OR) and 95% confidence intervals (CI) for PCR., Results: This analysis included 961,208 cataract operations performed on 682,381 patients from 136 participating centres by 3198 surgeons. 9730 (1.01%) of surgeries were complicated by PCR. The median age was 75.7 and 76.7 years for first and second eye surgery respectively, and 5154 (53.0%) were female. The highest risk factors for PCR were less experienced trainee surgeon (OR 3.75, 95% CI 3.33-4.24, p < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05-3.94, p < 0.001), younger males (OR 3.05, 95% CI 2.23-4.16, p < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24-2.60, p < 0.001). Other risk factors identified were glaucoma, worse preoperative VA, previous intravitreal therapy, high myopia, previous vitrectomy, systemic diabetes, diabetic retinopathy, amblyopia, older age, shallower ACD and inability to lie flat and cooperate., Conclusion: Various surgical, patient and ocular factors increase the risk of PCR during cataract surgery. This risk factor model permits estimation of individualised risks for patients and allows risk-adjustment for surgeons to evaluate their PCR rates based on case complexity., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Telemedicine, the use of telecommunication and information technology to deliver healthcare remotely, has evolved beyond recognition since its inception in the 1970s. Advances in telecommunication infrastructure, the advent of the Internet, exponential growth in computing power and associated computer-aided diagnosis, and medical imaging developments have created an environment where telemedicine is more accessible and capable than ever before, particularly in the field of ophthalmology. Ever-increasing global demand for ophthalmic services due to population growth and ageing together with insufficient supply of ophthalmologists requires new models of healthcare provision integrating telemedicine to meet present day challenges, with the recent COVID-19 pandemic providing the catalyst for the widespread adoption and acceptance of teleophthalmology. In this review we discuss the history, present and future application of telemedicine within the field of ophthalmology, and specifically retinal disease. We consider the strengths and limitations of teleophthalmology, its role in screening, community and hospital management of retinal disease, patient and clinician attitudes, and barriers to its adoption., (© 2023. The Author(s).)

Background: Recurrent corneal erosion syndrome (RCES) is caused by repeated episodes of corneal epithelial breakdown due to improper adherence of the corneal epithelium to the underlying basement membrane. The most common aetiologies are corneal dystrophy or previous superficial ocular trauma. The incidence and prevalence of the condition is currently unknown. This study aimed to determine the incidence and prevalence of RCES within the London population over a 5-year period in order to better inform clinicians and evaluate how this condition affects ophthalmic service provision., Methods: A retrospective cohort study over a 5-year period reviewed 487,690 emergency room patient attendances at Moorfields Eye Hospital (MEH) London between 1 January 2015 and 31 December 2019. MEH caters for a local population comprising of around ten regional clinical commissioning groups (CCGs). The data for this study were collected using OpenEyes TM electronic medical records including demographics and comorbidities. The CCGs encompass 41% (3,689,000) of London's total 8,980,000 inhabitants. Using these data the crude incidence and prevalence rates of disease were estimated with results reported per 100,000 population., Results: Out of 330,684 patients, 3623 patients were given a new diagnosis of RCES by the emergency ophthalmology services, and from these, 1056 patients attended outpatient follow-up. The crude annual incidence of RCES was estimated at 25.4 per 100,000, with a crude prevalence rate of 0.96%. There was no statistical difference in annual incidence across the 5-year period., Conclusions: The period prevalence of 0.96% shows that RCES is not uncommon. There was also a stable annual incidence over the 5-year period, showing no changing trend over the study period. However, identifying the true incidence and period prevalence is a challenging task, as minor cases may heal prior to examination by an ophthalmologist. It is highly likely that RCES is underdiagnosed and therefore underreported., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Introduction: Few studies have explored MultiColor™ imaging (MCI) in evaluating retinal vascular diseases, particularly branch retinal vein occlusion (BRVO). This study aimed to compare the identification of retinal vessel whitening in BRVO using MCI by scanning confocal laser versus conventional white-flash color fundus photography (CFP)., Methods: Paired images of consecutive patients diagnosed with BRVO who underwent same-day MCI and CFP were reviewed. Visualization of vessel whitening on MCI and CFP was graded and scored using a scale by two masked graders. A longitudinal analysis of the vessel grading score was performed to evaluate the vessel whitening detection by MCI. A correlation analysis was conducted between vessel whitening on MCI and the measured area of retinal ischemia on fluorescein angiography to evaluate the MCI performance., Results: Forty-four eyes of 41 patients (mean age 69 ± 14 years; 61% female) were analyzed. MCI demonstrated superior vessel whitening visibility score than CFP (p < 0.001). Longitudinal analysis showed no significant changes in vessel whitening visibility scores over a mean follow-up time of 430 ± 648 days (p = 0.655). There was a significantly positive correlation between the grading score of vessels whitening by MCI and the area of ischemia by fluorescein angiography (r2 = 0.15; p = 0.036)., Conclusion: MCI appears to provide a superior detection of whitening BRVO compared to CFP, serving as a rapid and non-invasive correlate of retinal ischemia., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Importance: Children born preterm (<37 weeks' gestation) have a higher risk of visual impairment and ocular morbidities compared peers born at full term. However, the long-term ocular sequelae in adulthood for those born extremely preterm (EP), who have the highest risk of neonatal retinopathy, are unknown., Objective: To evaluate visual function and ocular morbidity in young adults born EP compared with controls born full term., Design, Setting, and Participants: This prospective cohort study of a geographically based birth cohort in the UK and Ireland born from March 1 through December 31, 1995, included 128 participants aged 19 years (born at 22-25 weeks' gestation) and 65 age-matched controls born at full term. Statistical analysis was performed from March 1, 2020, to November 26, 2021., Exposures: Participants underwent eye examinations as part of a comprehensive outcome evaluation., Main Outcomes and Measures: Best-corrected visual acuity, refractive status, contrast sensitivity, color vision, prevalence of strabismus and nystagmus, and patient-reported visual function, measured using the Health Utilities Index Mark 3., Results: The study comprised 128 participants (256 eyes; 68 female participants [53%]; mean [SD] age, 19.3 [0.5] years) and 65 age-matched controls born at full term (130 eyes; 40 female participants [62%]; mean [SD] age, 19.2 [0.5] years). Compared with control eyes, the mean (SD) best-corrected visual acuity among eyes in the EP group was significantly worse (monocular vision: -0.06 [0.14] logMAR in the control group vs 0.14 [0.38] logMAR in the EP group; P < .001; binocular vision: -0.14 [0.15] logMAR in the control group vs 0.06 [0.37] logMAR in the EP group; P < .001). Participants in the EP group had a significantly higher prevalence of strabismus (36% [46 of 127] vs 0%; P < .001), abnormal ocular motility (15% [19 of 125] vs 0%; P < .001), and nystagmus (13% [16 of 127] vs 0%; P < .001) than the control group. No significant differences between participants in the EP group and controls were observed for refractive error, contrast sensitivity, color vision, or patient-reported visual function. Among the participants in the EP group, 48% of eyes (120 of 250) had no retinopathy of prematurity (ROP), 39% (98 of 250) had ROP not requiring neonatal treatment, and 13% (32 of 250) received cryotherapy or laser ablation for ROP. Within the EP group, there was no significant difference in binocular visual function parameters, prevalence of ocular morbidity, and patient-reported visual function by neonatal ROP status., Conclusions and Relevance: Extreme prematurity is associated with an increased prevalence of visual and ocular deficits in young adulthood; this study suggests that, for individuals born EP, visual and ocular deficits appear to be partially independent of ROP status in the neonatal period but reports similar overall visual function.

Recent improvements in ophthalmic imaging have led to the identification of a thickened choroid or pachychoroid to be associated with a number of retinal diseases. The number of conditions linked to this phenotype has continued to widen with specific endophenotypes found within the pachychoroid spectrum. The spectrum includes choroidal features such as focal or diffuse choroidal thickening and thinning of the overlying inner choroid, and choroidal hyperpermeability as demonstrated by indocyanine green angiography. In addition, these diseases are associated with overlying retinal pigmentary changes and retinal pigment epithelial dysfunction and may also be associated with choroidal neovascularization. This article provides a comprehensive review of the literature looking at diseases currently described within the pachychoroid spectrum including central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid disease and focal choroidal excavation. We particularly focus on clinical imaging, genetics and pathological findings in these conditions with the aim of updating evidence suggesting a common aetiology between diseases within the pachychoroid spectrum., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: The presentation of idiopathic intracranial hypertension (IIH) in association with iron deficiency anemia (IDA) is rare., Case Presentation: This case report depicts the unusual case of a 31-year-old woman of mixed Jamaican and English heritage with IIH who presented initially as IDA in the context of menorrhagia. Subsequent ophthalmic review, lumbar puncture, cerebrospinal fluid analysis and neuroimaging studies revealed severe bilateral optic disc swelling and raised intracranial pressure in keeping with IIH. Prompt treatment of IDA with blood transfusion and orally administered iron supplements, in addition to medical treatment for IIH, contributed to significant improvement of symptoms and prevented long-term visual deficits., Conclusion: The possibility of IDA, albeit rare, should always be considered and investigated appropriately in all patients with IIH, as the treatment of the anemia alone may be sight-saving.

The gastrointestinal tract (GIT) plays a key role in regulating nutrient metabolism and appetite responses. This study aimed to identify changes in the GIT that are important in the development of diet related obesity and diabetes. GIT samples were obtained from C57BL/6J male mice chronically fed a control diet or a high sucrose diet (HSD) and analysed for changes in gene, protein and metabolite levels. In HSD mice, GIT expression levels of fat oxidation genes were reduced, and increased de novo lipogenesis was evident in ileum. Gene expression levels of the putative sugar sensor, slc5a4a and slc5a4b , and fat sensor, cd36 , were downregulated in the small intestines of HSD mice. In HSD mice, there was also evidence of bacterial overgrowth and a lipopolysaccharide activated inflammatory pathway involving inducible nitric oxide synthase (iNOS). In Caco-2 cells, sucrose significantly increased the expression levels of the nos2 , iNOS and nitric oxide (NO) gas levels. In conclusion, sucrose fed induced obesity/diabetes is associated with changes in GI macronutrient sensing, appetite regulation and nutrient metabolism and intestinal microflora. These may be important drivers, and thus therapeutic targets, of diet-related metabolic disease.

Background: To assess the utility of enhanced depth imaging optical coherence tomography (EDI-OCT), compared with other conventional imaging modalities, for detecting and characterizing optic nerve head drusen (ONHD) in children., Methods: We report a retrospective cross-sectional case series of consecutive pediatric patients (age ≤16 years) with ONHD confirmed using B-scan ultrasonography. All eyes were evaluated using spectral-domain OCT of the optic nerve head in conventional (non-EDI) and EDI modes, fundus autofluorescence (FAF), and standard automated perimetry. Detection rates and the capacity to characterize ONHD were compared between EDI-OCT, non-EDI-OCT, and FAF., Results: Twenty-eight eyes of 15 patients (mean age 11 years; 60% female) were identified with definite ONHD that were confirmed by B-scan ultrasound. Among the technologies, EDI-OCT, non-EDI-OCT, FAF, and automated perimetry had findings consistent with ONHD in 24, 21, 18, and 4 eyes, respectively. EDI-OCT had a significantly better detection capability (86% of eyes) compared with FAF (P = 0.04) but not with non-EDI-OCT (P = 0.15). Similar to results previously reported in adult patients, EDI-OCT detected ONHD at different levels of depth; most were located anterior to the lamina cribrosa. ONHD detected by EDI-OCT appeared as hypo-reflective ovoid regions bordered by hyper-reflective material or as isolated hyper-reflective bands without a hypo-reflective core. The mean greatest diameter of ONHD seen on EDI-OCT was 449.7 (SD ±114.1) μm., Conclusions: EDI-OCT detects ONHD in most eyes identified as having drusen on B-scan ultrasonography. This technique has the potential to be an effective alternative first-line diagnostic and monitoring tool for ONHD, particularly for detecting buried drusen in children.

Purpose of Review: This review aims to evaluate the latest evidence on the treatment options for perceived poor responders to bariatric surgery and provide practitioners with a guide on when to consider revisional surgery and when to consider alternatives., Recent Findings: The use of adjuvant pharmacotherapy has been increasingly described in the literature as an adjunct to primary bariatric surgery, in order to attain more weight loss or better control of obesity-related complications. The newer anti-obesity and anti-diabetes drugs also have cardiorenal benefits, which are shown in recent cardiovascular outcome trials. Revisional bariatric surgery has emerged as a distinctive entity and can be broadly organized into three categories: corrective, conversion, and reversal surgeries. Careful patient selection and preoperative optimization are needed to ensure long-term favorable outcomes. Newer treatment modalities involving the use of anti-obesity medications and endoscopic bariatric interventions provide patients and healthcare providers with more options, when faced with the challenge of poor response after bariatric surgery.

Background: Ophthalmic emergencies comprise a significant portion of junior doctors' workload in accident and emergency (A&E). However, previous studies have demonstrated a lack of training and confidence in the management of such emergencies. This study assessed changes in basic ophthalmic training that A&E junior doctors received in dealing with eye emergencies, their perceived level of confidence and the availability of appropriate ophthalmic equipment in A&E over the last 15 years., Methods: A prospective, national, combined online and telephone survey using a previously published questionnaire was performed. Foundation year two doctors (FY2s) from each A&E department in the UK listed on the official NHS directory were contacted for participation., Results: Two hundred and ten A&E departments were contacted and 202 responded (response rate of 96.2%). There was no significant change in the number of A&E departments equipped with slit lamps (82.5% in 2003 vs 79.7% in 2018; p = 0.26). However, the prevalence of training in its use has decreased significantly (68.4% in 2003 vs 52% in 2018; p = 0.005). There was also a significant reduction in the prevalence of training in the management of eye emergencies (77.4% in 2003 vs 45.5% in 2018; p < 0.001) and the proportion of FY2s who felt confident in dealing with such cases (36.1% in 2003 vs 6% in 2018; p < 0.001)., Conclusion: There is a concerning decline in basic ophthalmic training for A&E FY2s, reflected by the alarmingly low level of confidence in the management of eye emergencies. This highlights an urgent need to improve ophthalmic training for junior doctors in A&E.

Background and Aim: A wide variety of foreign bodies have been found in the urinary bladder, most often due to self-introduction and autoerotism, or iatrogenically introduced during surgery in the anatomic region. We report the first case of a gastric banding clip found in the urinary bladder., Case Presentation: We describe the case of a 33-year-old Chinese female who had previously undergone gastric banding and subsequent removal of the band. She presented with lower urinary tract symptoms which followed a diurnal pattern, and investigations revealed a portion of a gastric banding clip in the urinary bladder. There was no sign of perforation or erosion of the bladder. The clip was surgically removed and the patient recovered without complications., Discussion and Conclusion: This is the first reported case of an intraperitoneal gastric banding clip migrating extraperitoneally into the urinary bladder. The use of the urinary bladder to expel foreign bodies has been documented in other vertebrates, and the mechanism by which this occurs without perforation or erosion of the urinary bladder warrants further investigation.

Competing Interests: Competing interests: None declared.

Purpose: To explore factors that influence the success of adult strabismus surgery based on health-related quality of life (HRQOL) criteria., Methods: The HRQOL aspect of strabismus surgery was assessed using the Adult Strabismus 20 (AS-20) questionnaire. Adult patients (≥16 years of age) undergoing strabismus surgery between 2014 and 2016 were identified using a treatment register. Pre- and postoperative AS-20 scores were calculated. HRQOL surgical success was defined as a pre- to postoperative change in AS-20 score exceeding previously published 95% limits of agreement. Any relationship between demographic factors (sex, age, and socioeconomic status), presence or absence of diplopia, type and magnitude of deviation, and change in deviation size with HRQOL success was investigated., Results: A total of 87 patients were included (mean age, 47 years; 53% female). Nondiplopic patients showed significantly lower pre- and postoperative scores on the AS-20 psychosocial subscale compared to diplopic patients. Of 87 surgeries, 54 (62%) were classified as successful based on HRQOL criteria. Multiple logistic regression analysis showed only lower socioeconomic status to be significantly associated with a higher rate of HRQOL success (P = 0.04)., Conclusions: Strabismic patients with a lower socioeconomic status are more likely to achieve HRQOL success following surgery. We also show that nondiplopic patients have more psychosocial concerns than those with diplopia and that this disparity persists even after strabismus surgery., (Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

This case report depicts the clinical course of a female patient with unilateral retinitis pigmentosa, who first presented at the age of 12 years. Fundus photography at the time revealed unilateral pigmentary retinopathy, which was associated with extinguished electroretinogram (ERG) signal. At 35 years of age, fundus examination revealed deterioration of pre-existing unilateral pigmentary retinopathy with progressive visual field defect detected on Goldmann visual field testing. ERG findings remained unchanged and multifocal ERG showed unilateral decrease in amplitude in the affected eye. The patient was referred for genetic counselling. Next-generation sequencing identified a deleterious heterozygous c.118T>G (p.Cys40Gly) mutation in the CLRN1 gene., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: To assess the effect of switching patients previously incompletely treated with ranibizumab (RBZ) to aflibercept (AFL) using a pro re nata (PRN) treatment strategy in neovascular age-related macular degeneration (nvAMD)., Methods: A retrospective case series was conducted on patients who had persistent or recurrent intra- and/or sub-retinal fluid treated initially with RBZ and subsequently switched to AFL. The main outcome measures were best corrected visual acuity (BCVA) and central retinal thickness (CRT) measured at different stages of the study. Friedman analysis of variance and Wilcoxon test were used to examine differences in BCVA and CRT., Results: Two hundred and seven eyes from 182 patients were included. BCVA and CRT improved significantly initially following 3 RBZ injections with a mean gain of 3.7 letters (p < 0.001) and a mean loss of 69 μm (p < 0.001) respectively. Following PRN RBZ therapy and immediately prior to switching to AFL (mean 129 weeks), there was a mean loss of 6.7 letters (p < 0.001) BCVA and a mean gain of 24 μm (p < 0.001) CRT. AFL loading resulted in a mean improvement of 0.7 letters (p = 0.28) BCVA and 55 μm (p < 0.001) CRT. At final follow-up following AFL PRN therapy (mean 85 weeks), there was a mean loss of 8.9 letters (p < 0.001) BCVA and a mean gain of 12 μm (p < 0.05) CRT., Conclusion: AFL loading resulted in a significant anatomical improvement but no significant change in visual acuity. However, the benefits of switching were gradually lost over time with AFL PRN dosing despite an increased injection rate when compared with RBZ PRN treatment., Trial Registration: Not applicable.

Objectives: To assess the time from symptom onset to treatment for neovascular age-related macular degeneration (nvAMD) and to measure the awareness of AMD in Southeast Scotland., Design: Retrospective cross-sectional study., Setting: Secondary care, Southeast of Scotland., Methods: Patients treated with intravitreal therapy (IVT) for nvAMD in Southeast Scotland between 2013 and 2015 were identified using a treatment register. Notes were retrospectively reviewed. We measured time from: (A) symptom onset to first presentation at primary care, (B) referral to ophthalmic clinic appointment and (C) ophthalmic clinic appointment to first IVT treatment. To investigate AMD awareness, we performed a cluster random sample survey of patients visiting non-AMD ophthalmic clinics using a previously validated 12-item questionnaire., Results: 195 patients (mean age 78 years) were included in the study. The mean delays between the different stages-A, B and C-were 54.2 (95% CI ±13), 28.2 (95% CI ±4.0) and 31.5 (95% CI ±3.6) days, respectively. There was an additional mean delay of 7.5 (95% CI ±1.6) days when patients were indirectly referred by optometrists via general practitioners (P<0.05). 140 patients (mean age 78) participated in the awareness survey; 62.1% reported being 'aware' of AMD but only 37.3% described AMD symptoms correctly., Conclusions: There was a significant delay at every step of the nvAMD care pathway. The causes for this were multifactorial and included delays in first presentation to a healthcare provider, referral from primary care and initiation of secondary care treatment. Our data are likely to underestimate prehospital delays as a large number of cases are likely to have undefined symptoms and onset. We also identified suboptimal awareness of AMD which could account for a substantial delay in presentation from symptom onset. These findings highlight the need to address AMD awareness and the need for urgent treatment to prevent avoidable vision loss resulting from nvAMD., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To determine the prevalence of vitamin D deficiency (<37.5 nmol/L) among young adolescents in Malaysia and its association with demographic characteristics, anthropometric measures and physical activity., Design: This is a cross-sectional study among Form 1 (year 7) students from 15 schools selected using a stratified random sampling design. Information regarding sociodemographic characteristics, clinical data and environmental factors was collected and blood samples were taken for total vitamin D. Descriptive and multivariable logistic regression was performed on the data., Setting: National secondary schools in Peninsular Malaysia., Participants: 1361 students (mean age 12.9±0.3 years) (61.4% girls) completed the consent forms and participated in this study. Students with a chronic health condition and/or who could not understand the questionnaires due to lack of literacy were excluded., Main Outcome Measures: Vitamin D status was determined through measurement of sera 25-hydroxyvitamin D (25(OH)D). Body mass index (BMI) was classified according to International Obesity Task Force (IOTF) criteria. Self-reported physical activity levels were assessed using the validated Malay version of the Physical Activity Questionnaire for Older Children (PAQ-C)., Results: Deficiency in vitamin D was seen in 78.9% of the participants. The deficiency was significantly higher in girls (92.6%, p<0.001), Indian adolescents (88.6%, p<0.001) and urban-living adolescents (88.8%, p<0.001). Females (OR=8.98; 95% CI 6.48 to 12.45), adolescents with wider waist circumference (OR=2.64; 95% CI 1.65 to 4.25) and in urban areas had higher risks (OR=3.57; 95% CI 2.54 to 5.02) of being vitamin D deficient., Conclusions: The study shows a high prevalence of vitamin D deficiency among young adolescents. Main risk factors are gender, ethnicity, place of residence and obesity., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Obesity and lack of physical activity are fast becoming a concern among Malaysian adolescents., Objective: This study aims to assess physical activity levels among Malaysian adolescents and investigate the association between physical activity levels and body composition such as body mass index (BMI), waist circumference (WC) and percentage of body fat., Subjects and Methods: 1361 school-going 13 year old multi-ethnic adolescents from population representative samples in Malaysia were involved in our study. Self-reported physical activity levels were assessed using the validated Malay version of the Physical Activity Questionnaire for Older Children (PAQ-C). Height, weight, body fat composition and waist circumference (WC) were measured. Data collection period was from March to May 2012., Results: 10.8% of the males and 7.4% of the females were obese according to the International Obesity Task Force standards. A majority of the adolescents (63.9%) were physically inactive. There is a weak but significant correlation between physical activity scores and the indicators of obesity. The adjusted coefficient for body fatness was relatively more closely correlated to physical activity scores followed by waist circumference and lastly BMI., Conclusion: This study demonstrates that high physical activity scores were associated with the decreased precursor risk factors of obesity., (Copyright © 2014. Published by Elsevier Inc.)

Objective: To compare the measurements of body fat percentage (BF%) using the foot-to-foot bioelectrical impedance analysis (FTF-BIA) with the direct segmental multifrequency BIA (DSM-BIA)., Methods: There were 36 men and 52 women (37.1 ± 14.3 years) with 57% Malays, 30% Chinese, and 13% Indian. For children, there were 45 boys and 26 girls (11.5 ± 2.5 years) with 52% Malay, 15% Chinese, and 33% Indian., Results: Mean height for men was 168.4 cm, 11 cm taller than women. Men were 10 kg heavier than women at 70 kg. BF% in women was 32% and 33% whereas BF% in men was 23% and 25% when measured using FTF-BIA and DSM-BIA, respectively. In children, BF% measured with FTF-BIA and DSM-BIA was 49% and 46%, respectively. The correlations were significant for men (r = 0.92, SEE = 2.80), women (r = 0.91, SEE = 3.31), boys (r = 0.95, SEE = 5.44), and girls (r = 0.96, SEE = 5.27). The BF% in underweight/normal (r = 0.92, SEE = 2.47) and that in overweight/obese adults (r = 0.89, SEE = 3.61) were strongly correlated. The correlations were significant in normal/underweight (r = 0.94, SEE = 3.78) and obese/overweight children (r = 0.83, SEE = 6.49). All ethnic groups showed significant correlation with BF%. Malay adults (r = 0.92, SEE = 3.27) and children (r = 0.94, SEE = 0.88) showed significant mean differences in BF%., Conclusion: The FTF-BIA showed higher accuracy for all normal/underweight and Chinese group with acceptable overestimation in children and underestimation in adults. Caution should be taken when interpreting BF% depending on gender, BMI, and ethnicity.